“Radioactive iodine therapy in low-risk pediatric thyroid cancer: universal standard or selective indication?”

Radioactive iodine (RAI) treatment in low-risk pediatric patients with differentiated thyroid cancer (DTC) is still debatable. The objective of this study is to evaluate the outcome of treated and untreated patients in pediatric age. The data of all pediatric patients affected by low-risk category DTC according to ATA (American Thyroid Association) during the period 2010–2024 were reviewed. Patients with DTC dimensions > 2 cm and/or lymph node involvement underwent to RAI. In our cohort 7/14 (50%) of subjects were treated with RAI. Cytological categories after FNAB were TIR3b in 2/7 (28.6%) and TIR5 in 5/7 (71.4%) for RAI-treated patients, whereas TIR3b was observed in 6/7 (85.7%) and TIR5 in 1/7 (14.3%) in untreated patients (p = 0.03). T1 stage was assigned in 1/7 (14.3%) of patient treated with RAI, T2 stage was present in the remaining 6/7 (85.7%), whereas T 1 stage was observed in 6/7 (85.7%) and T2 stage in 1/7 (14.3%) of untreated patients (p = 0.007). No difference was observed regarding disease persistence or recurrence between treated and untreated patients. Considering the young age, a case-by-case approach may be reasonable in subjects assigned to the low-risk category, rather than absolute recommendation for all pediatric patients with DTC.