6
Differentiated Thyroid Cancer
Table 3. ATA Pediatric Thyroid Cancer Risk Levels and
Postoperative Management in Children with
Papillary Thyroid Carcinoma
ATA Risk
Level
1
Definition
Initial
Postoperative
Staging
2
TSH Goal
3
Surveillance of
Patients With No
Evidence of
Disease
4
ATA
Pediatric
Low-Risk
Disease grossly
confined
to the thyroid
with N0/Nx
disease or
patients with
incidental N1a
disease
(microscopic
metastasis
to a small
number of
central neck
lymph
nodes)
Tg
5
0.5 – 1.0
mIU/L
US at 6 months
postoperatively and
then annually × 5
years
Tg
5
on LT4 every
3-6 months for two
years and then
annually
ATA
Pediatric
Intermediate-
Risk
Extensive N1a
or minimal
N1b disease
TSH-
Stimulated
Tg
5
and
diagnostic
123
I
scan in most
patients
(See Figure 2)
0.1 – 0.5
mIU/L
US at 6 months
postoperatively,
every 6-12 months
for 5 years, and
then less frequently
Tg
5
on LT4 every
3-6 months for 3
years and then
annually
Consider TSH-
stimulated Tg
5
±
diagnostic
123
I scan
in 1-2 years in
patients treated
with
131
I
ATA
Pediatric
High-Risk
Regionally
extensive
disease
(extensive N1b)
or locally
invasive
disease (T4
tumors), with
or without
distant
metastasis
TSH-
Stimulated
Tg
5
and
diagnostic
123
I
scan in all
patients
(See Figure 2)
< 0.1
mIU/L
US at 6 months
postoperatively,
every 6-12 months
for 5 years, and
then less frequently
Tg5 on LT4 every
3-6 months for 3
years and then
annually
TSH-stimulated
Tg5 ± diagnostic
123
I scan in 1-2 years
in patients treated
with
131
I
