Pediatric thyroid nodules differ in significant ways from their adult counterparts. Thyroid nodules are less common in children overall, but the relative risk of malignancy is higher. Pediatric cancers are more frequently encountered in the setting of prior radiation exposure, whereas a small subset is associated with inherited syndromes, such as those seen with APC, DICER1, or PTEN mutations. Although a large majority of these cancers are papillary carcinomas, the mutational profile of these tumors differs from the adult population with a lower frequency of BRAFV600E point mutations and a higher incidence of RET/PTCtranslocations. The clinical management of pediatric thyroid cancer also poses unique challenges. Even in patients with advanced tumors, disease-specific mortality is low. Morbidity is often secondary to treatment and potentially includes long-term effects of radiation therapy. At the same time, there is a natural tension between the desire to avoid excessive treatment and the potential implications of insufficiently aggressive intervention in a young patient with a lengthy anticipated lifespan.
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