Recent Advances in Diagnostics and Therapeutics for Paediatric Thyroid Cancer.

Joel A Vanderniet, David K V Chung, Yoon Hi Cho, Paul Z Benitez-Aguirre, Noemi A Fuentes-Bolanos, Gideon Sandler, Ali Moghimi, Bhavna Padhye, Kathy Tucker, Antoinette Anazodo

Journal: Journal of paediatrics and child health 2025;61(5):666-675

PMID: 39934993

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Abstract

PURPOSE OF REVIEW

Paediatric thyroid cancer management traditionally relied on extrapolation from adult data and, despite good survival outcomes, often involved extensive surgical approaches and radioactive iodine (RAI) therapy with potentially life-long complications. Increasing understanding of paediatric diagnostic techniques, molecular tumour drivers and targeted therapies will allow a more nuanced, disease-specific comprehensive model of care. This review summarises recent developments in paediatric thyroid cancer biology, diagnosis and models of care.

METHODS

Review of relevant literature from the last 5 years to inform a narrative summary by a multidisciplinary team of clinician experts in paediatric thyroid cancer management.

FINDINGS

Standardised risk scoring systems will likely improve the objectivity and accuracy of paediatric thyroid nodule risk stratification on ultrasound, but further studies are needed to validate these. Identification of somatic and germline gene variants is playing a rapidly increasing role in paediatric thyroid cancer diagnosis and planning of surgical approaches and neoadjuvant and adjuvant therapies. There is growing recognition that lobectomy may achieve comparable outcomes, with reduced risk of complications, to total thyroidectomy in patients with low-risk disease. Molecularly targeted therapies are now available for the management of advanced disease as an adjuvant, and likely neo-adjuvant, therapy for medical debulking of large tumours and resensitisation of RAI-resistant disease.

CONCLUSIONS

The management pathways for paediatric thyroid cancer are rapidly evolving due to the increasing availability of paediatric-specific data. As management options become more complex, interdisciplinary collaboration and shared decision-making are ever more important.

© 2025 The Author(s). Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Address: Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.; Institute of Endocrinology and Diabetes, the Children's Hospital at Westmead, Sydney, New South Wales, Australia.; School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.; Children's Cancer Institute, Lowy Cancer Centre, University of New South Wales, Sydney, New South Wales, Australia.; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.; Institute of Endocrinology and Diabetes, the Children's Hospital at Westmead, Sydney, New South Wales, Australia.; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.; Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.; Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.; Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.; Department of Histopathology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.; Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.; School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.; Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, New South Wales, Australia.; School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.; Nelune Cancer Centre, Prince of Wales Hospital, Sydney, New South Wales, Australia.

DOI: 10.1111/jpc.70013