# Thyroid Nodules — GCMD Library living collection

Everything in the library about thyroid nodules — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 81 cited statements

## Episodes
### Surgical Management
- [Pediatric Thyroid Disorders: Update Course 2016](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923) — video · 31:12 · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923.md)
- [Update Course Rewind 2025: Nerve Monitoring in Pediatric Thyroid Surgery](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577) — video · 6:20 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577.md)

### In-Depth Reviews
- [Thyroid Disorders](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302) — podcast · 45:51 · [machine version](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=0) Introduction and Background (Ep 2)
- [2:29](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=149) Initial Evaluation of Thyroid Nodules (Ep 2)
- [6:56](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=416) Laboratory and Imaging Workup (Ep 2)
- [9:26](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=566) Ultrasound Characteristics and Biopsy Criteria (Ep 2)
- [11:40](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=700) FNA Technique and Papillary Cancer Diagnosis (Ep 2)
- [14:17](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=857) Surgical Management of Papillary Thyroid Cancer (Ep 2)
- [17:40](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1060) Postoperative Management and Risk Stratification (Ep 2)
- [21:48](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1308) Follicular Lesions and Indeterminate Cytology (Ep 2)
- [24:39](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1479) Frozen Section and Follicular Cancer Management (Ep 2)
- [27:53](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1673) Benign Nodules and Inadequate Specimens (Ep 2)
- [30:08](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1808) Medullary Thyroid Cancer: Initial Workup (Ep 2)
- [35:20](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2120) MEN Syndromes and Prophylactic Thyroidectomy (Ep 2)
- [39:27](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2367) Medullary Cancer: Postoperative Management (Ep 2)
- [41:59](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2519) Graves' Disease and Diffuse Papillary Cancer (Ep 2)
- [44:23](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2663) Closing Remarks (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=0) Volume-Outcome Relationships in Thyroid Surgery (Ep 1)
- [8:18](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=498) Interpreting Volume Data and Building Practice (Ep 1)
- [12:18](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=738) Endocrine-Specific Complications and ATA Guidelines (Ep 1)
- [23:21](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1401) Multidisciplinary Tumor Boards and Parathyroid Management (Ep 1)
- [28:54](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1734) Maintaining Competency and Double-Scrubbing (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=0) Case presentation and initial management of pediatric thyroid nodule (Ep 3)
- [2:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=127) Intraoperative nerve monitoring technique and evidence (Ep 3)
- [4:28](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=268) Technical considerations and modified TIRRADS for pediatrics (Ep 3)
- [5:42](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=342) Summary and conclusions (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Thyroid nodules are less common in children than adults, but when detected in children, they are more likely to be malignant. — Diana Deason (epidemiological) [Ep 2 · 6:23](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=383)
- When children present with thyroid cancer, they are more likely to have extension outside of the thyroid, regional lymph node involvement, and distant metastasis compared to adults. — Diana Deason (clinical) [Ep 2 · 6:31](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=391)
- Risk factors for thyroid nodules and cancer include previous exposure to radiation or alkylating agents, such as treatment for Hodgkin's lymphoma, leukemia, or CNS tumors. — Diana Deason (clinical) [Ep 2 · 4:08](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=248)
- Some thyroid conditions and thyroid cancers have familial predisposition, including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes. — Diana Deason (clinical) [Ep 2 · 4:27](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=267)
- If TSH is suppressed, a nuclear thyroid scan should be obtained to identify hyperfunctioning nodules, which do not need to be biopsied if they are going to be resected. — Diana Deason (guideline) [Ep 2 · 7:24](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=444)
- Suspicious ultrasound features for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, microcalcifications, or association with abnormal lymph nodes. — Diana Deason (clinical) [Ep 2 · 9:57](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=597)
- In pediatric patients, size cutoffs used in adults (1 cm) cannot be applied for biopsy decisions; ultrasound characteristics and clinical context determine whether FNA is warranted. — Diana Deason (guideline) [Ep 2 · 11:21](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=681)
- Total or near-total thyroidectomy is recommended for papillary thyroid cancer due to risk of bilateral disease (up to 30%), multifocal disease (up to 65%), increased risk of recurrence with lobectomy alone, and ability to optimize for radioactive iodine and use thyroglobulin as a tumor marker. — Diana Deason (guideline) [Ep 2 · 15:00](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=900)
- Nerve monitoring is used routinely during thyroidectomy, and while it does not decrease the risk of nerve injury, it is helpful in identifying the recurrent laryngeal nerve, especially in patients with bulky cervical disease. — Diana Deason (opinion) [Ep 2 · 17:07](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1027)
- There is no evidence to support prophylactic lateral neck dissection in thyroid cancer; lateral neck dissection is performed only when lateral nodes are pathologically positive. — Diana Deason (guideline) [Ep 2 · 18:33](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1113)
- After total thyroidectomy, PTH levels less than 10 to 15 in recovery indicate higher risk for hypocalcemia, prompting initiation of calcium replacement or calcitriol. — Diana Deason (clinical) [Ep 2 · 19:37](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1177)
- Low-risk papillary thyroid cancer patients (disease confined to thyroid, no nodal involvement, T1B N0) require only thyroglobulin surveillance with TSH suppression to 0.5-1, ultrasound at 6 months postoperatively, then annually for 5 years. — Diana Deason (guideline) [Ep 2 · 21:12](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1272)
- Intermediate-risk patients (extensive central neck disease or any lateral neck disease) and high-risk patients (extensive regional disease, local invasion, or distant metastases) may require radioactive iodine postoperatively. — Diana Deason (guideline) [Ep 2 · 21:48](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1308)
- Follicular lesions represent about one-third of thyroid FNA results and are indeterminate specimens. — Diana Deason (epidemiological) [Ep 2 · 23:05](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1385)
- For follicular lesions of undetermined significance, the risk of malignancy in adults is 5-15%, but in pediatric literature it is approximately 28%. — Diana Deason (epidemiological) [Ep 2 · 24:07](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1447)
- For follicular neoplasms, the reported malignancy rate was 15-30%, but more recent data suggests it is between 50% and 60% in children. — Diana Deason (epidemiological) [Ep 2 · 24:18](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1458)
- Current ATA recommendations are that all indeterminate (follicular) lesions in children be resected, typically with lobectomy and removal of the isthmus. — Diana Deason (guideline) [Ep 2 · 23:50](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1430)
- Frozen section cannot distinguish follicular adenoma from follicular carcinoma, but can identify papillary components. — Diana Deason (clinical) [Ep 2 · 25:04](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1504)
- For follicular carcinoma with significant vascular invasion or tumor greater than 4 cm, completion thyroidectomy is recommended; smaller tumors with minimal vascular invasion can be monitored. — Diana Deason (guideline) [Ep 2 · 26:10](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1570)
- About 30% of patients who undergo lobectomy may develop hypothyroidism at some point, so thyroid function monitoring is important even after partial thyroidectomy. — Diana Deason (epidemiological) [Ep 2 · 27:01](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1621)
- TSH suppression goals vary by ATA pediatric risk level: low-risk patients have a TSH goal of 0.5-1, while high-risk patients have a TSH goal of less than 0.1. — Diana Deason (guideline) [Ep 2 · 27:31](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1651)
- For benign thyroid nodules greater than 4 cm, the sensitivity and specificity of FNA is decreased, so it is important to follow these lesions with repeat ultrasound in 6-12 months and repeat biopsy if enlarging or developing suspicious features. — Diana Deason (clinical) [Ep 2 · 28:49](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1729)
- Inadequate FNA specimens occur in roughly 1-3% of cases and should be repeated in 3-6 months to avoid picking up atypia from trauma of the initial FNA. — Diana Deason (clinical) [Ep 2 · 29:49](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1789)
- Sporadic medullary thyroid cancer is unusual in children, so routine calcitonin monitoring is not recommended for every child with a thyroid nodule. — Diana Deason (guideline) [Ep 2 · 31:34](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1894)
- For medullary thyroid cancer, if initial calcitonin level is greater than 500, imaging should be performed to exclude metastatic disease, including CT of neck and chest, MRI or CT of abdomen (looking at liver), and bone scan. — Diana Deason (guideline) [Ep 2 · 33:01](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1981)
- MEN 2A patients can develop medullary thyroid cancer, pheochromocytomas, and hyperparathyroidism. — Diana Deason (clinical) [Ep 2 · 33:36](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2016)
- MEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and a Marfanoid habitus with elongated features and joint laxity. — Diana Deason (clinical) [Ep 2 · 33:47](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2027)
- MEN 2B patients with RET 918 mutation present with thyroid cancer very early, as young as 3 months of age, and require thyroidectomy before 1 year of age. — Diana Deason (guideline) [Ep 2 · 34:11](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2051)
- MEN 2A high-risk patients (most commonly RET 634 mutation) should have total thyroidectomy before age 5, with surveillance starting at age 3 including calcitonin, CEA, and ultrasounds; if calcitonin or ultrasound abnormalities develop, thyroidectomy should be performed at that time. — Diana Deason (guideline) [Ep 2 · 36:03](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2163)
- If calcitonin levels exceed 40 in MEN patients undergoing surveillance, central neck dissection is recommended at the time of thyroidectomy. — Diana Deason (guideline) [Ep 2 · 36:27](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2187)
- Children under age 10 have increased risk of complications from thyroidectomy, including hypoparathyroidism and nerve injury, due to smaller anatomy and smaller parathyroid glands. — Diana Deason (clinical) [Ep 2 · 36:52](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2212)
- For MEN 2A moderate-risk patients, total thyroidectomy is recommended when serum calcitonin becomes elevated or if parents do not want to proceed with frequent surveillance. — Diana Deason (guideline) [Ep 2 · 36:59](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2219)
- MEN 2A moderate-risk patients do not tend to develop pheochromocytomas until their twenties or above, so screening begins at age 16; MEN 2A high-risk patients begin pheochromocytoma screening at age 11. — Diana Deason (guideline) [Ep 2 · 37:47](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2267)
- For prophylactic thyroidectomy in MEN patients, if performed before calcitonin levels exceed 40, central lymph node dissection is not necessary. — Diana Deason (guideline) [Ep 2 · 39:03](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2343)
- After thyroidectomy for medullary cancer, if calcitonin levels are undetectable or normal, surveillance includes physical exam and neck ultrasounds every 6 months for 1 year, then annually. — Diana Deason (guideline) [Ep 2 · 40:08](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2408)
- If postoperative calcitonin levels are greater than 150, imaging should be performed to detect metastasis, including CT neck and chest, MRI or CT abdomen, bone scan, and MRI of pelvis and axial skeleton. — Diana Deason (guideline) [Ep 2 · 40:22](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2422)
- Systemic therapy for medullary thyroid cancer (tyrosine kinase inhibitors, external beam radiation) has significant side effects and is reserved for patients with progressive disease not treatable with surgery, not for all patients with elevated calcitonin. — Diana Deason (guideline) [Ep 2 · 41:38](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2498)
- For Graves' disease in young children, thyroidectomy is often preferred over radioactive iodine due to concerns about risks of secondary malignancies from radioactive iodine. — Diana Deason (opinion) [Ep 2 · 42:29](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2549)
- Some pediatric patients with papillary thyroid cancer present with diffuse infiltration of the thyroid rather than a discrete nodule, often with clinically suspicious lymph nodes, which is a characteristic more common in children. — Diana Deason (clinical) [Ep 2 · 43:52](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2632)
- For Bethesda 3 thyroid nodules in pediatrics, lobectomy is recommended rather than molecular testing or repeat FNA because there is a higher rate of malignancy in pediatric populations compared to adults — Ben Hamm (guideline) [Ep 3 · 0:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=52)
- For a nodule with intermediate risk of cancer (approximately 30% malignancy rate), hemithyroidectomy rather than total thyroidectomy is recommended — Ben Hamm (clinical) [Ep 3 · 1:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=70)
- The 2015 pediatric guidelines recommend thyroid surgery be done by a high volume thyroid surgeon — Ben Hamm (guideline) [Ep 3 · 1:28](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=88)
- One recent study published the rate of recurrent laryngeal nerve injury decreasing from 8% to 1.5% with nerve monitoring — Ben Hamm (clinical) [Ep 3 · 2:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=147)
- Studies in adults have shown that nerve monitoring helps identify the nerve more, but maybe doesn't change injury rates — Ben Hamm (clinical) [Ep 3 · 2:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=170)
- There are no studies in pediatrics showing significant decrease in injury rates with nerve monitoring, but there are several that show absolute decrease — Ben Hamm (clinical) [Ep 3 · 2:57](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=177)
- The evidence on whether intraoperative nerve monitoring prevents recurrent laryngeal nerve injury is mixed and open for meta-analysis — Ben Hamm (opinion) [Ep 3 · 3:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=188)
- Recurrent laryngeal nerve injury rate in children is 9% versus about 6% in adults, possibly because it's a smaller nerve that may be harder to identify — Ben Hamm (epidemiological) [Ep 3 · 3:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=200)
- If injury is detected on one side with nerve monitoring, the surgeon may want to wait and see if it's a transient injury that can recover later — Ben Hamm (clinical) [Ep 3 · 3:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=218)
- Expense is one consideration as a downside to nerve monitoring — Ben Hamm (opinion) [Ep 3 · 3:49](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=229)
- Some have questioned why use nerve monitoring if it doesn't change injury rates or outcomes — Ben Hamm (opinion) [Ep 3 · 3:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=232)
- Recent endotracheal tube electrode publications show nerve monitoring has been tried in patients down to age 0 — Ben Hamm (clinical) [Ep 3 · 4:04](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=244)
- Nerve monitoring is most beneficial when doing a total thyroidectomy where the contralateral cord is at risk, to help decrease the risk of tracheotomy with bilateral paralysis — Ben Hamm (clinical) [Ep 3 · 4:28](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=268)
- If a child is too small for the endotracheal tube electrodes, the electrodes come separate and can be placed directly into the vocalis muscle via direct laryngoscopy for monitoring (clinical) [Ep 3 · 4:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=280)
- A recent paper suggested that if you adjust the size criteria in TIRRADS, it actually performs better than the 2015 pediatric guidelines — Ben Hamm (clinical) [Ep 3 · 5:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=300)
- A larger institutional study through the Pediatric Surgical Oncology Research Collaborative using the modified PES-TIRRADS recommends biopsy for every TIRRADS 3 nodule over 1 cm or TIRRADS 4-5 over 0.5 cm (guideline) [Ep 3 · 5:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=313)
- There is a definite increase in pediatric thyroid disease incidence over two decades according to SEER database, including large thyroid nodules not attributable to better screening. — Jason (epidemiological) [Ep 1 · 2:12](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=132)
- Approximately 4-5% of children have a thyroid nodule, and of those, approximately 30% are malignant. — Jason (epidemiological) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=180)
- In adults, thyroid nodules are more prevalent but malignancy rate is lower—an inverse ratio compared to pediatrics. — Jason (epidemiological) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=180)
- In pediatric populations, thyroid cancers tend to have more nodal disease, are more multifocal, and are more likely to be metastatic to lung or bone compared to adults. — Jason (clinical) [Ep 1 · 4:00](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=240)
- Predictors of malignancy in pediatric thyroid nodules include male gender, compression symptoms, palpable lymphadenopathy, higher TSH, microcalcifications, indistinct margins, hypochoic pattern, and increased nodular vascularization. — Jason (clinical) [Ep 1 · 4:40](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=280)
- The incidence of differentiated thyroid cancer in hyperfunctioning nodules is upwards of 10 times higher in children than in adults, so general recommendations are to remove hyperfunctioning nodules in pediatric patients. — Jason (clinical) [Ep 1 · 5:40](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=340)
- In 10-40 year follow-ups of pediatric thyroid cancer, there is 98% overall survival, but of deaths that occur, two-thirds are from non-thyroid malignancies, and of those, most patients had received radiation. — Jason (epidemiological) [Ep 1 · 6:20](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=380)
- A Washington group study of approximately 4000 patients from the National Cancer Database found no difference in 15-20 year outcomes between partial thyroidectomy (ipsilateral thyroidectomy and isthmectomy) and total thyroidectomy for nodules over 1 centimeter. — Jason (clinical) [Ep 1 · 7:30](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=450)
- National Inpatient Sample data on approximately 1200 pediatric patients showed children had higher rates of both general and endocrine-specific complications (recurrent laryngeal nerve injury or hypocalcemia) compared to adult comparison cohorts. — Jason (epidemiological) [Ep 1 · 8:10](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=490)
- National Inpatient Sample data on approximately 16,000 adult patients over 10 years showed surgeons performing fewer than 25 thyroidectomies per year have significantly higher additional risk of overall complications compared to high-volume surgeons (>25 cases/year). — Jason (epidemiological) [Ep 1 · 8:30](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=510)
- A surgeon doing one thyroidectomy per year compared to a surgeon doing 25 per year is 90% more likely to have a complication. — Jason (epidemiological) [Ep 1 · 8:27](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=507)
- In pediatric patients, comparing high-volume (undefined threshold) and low-volume (1-2 cases per year) surgeons, there is nearly a twofold difference in inpatient overall complications. — Jason (epidemiological) [Ep 1 · 11:38](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=698)
- Only 5% of pediatric surgeons in the National Inpatient Sample were high-volume surgeons, meaning most pediatric surgeons doing thyroid surgery are low-volume surgeons. — Jason (epidemiological) [Ep 1 · 12:00](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=720)
- Relative risk factors for hypoparathyroidism include nodal dissection (over 2-fold higher risk), total thyroidectomy, Graves' disease operations, and malignancy. — Jason (clinical) [Ep 1 · 12:40](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=760)
- Overall rate of hypoparathyroidism after partial or total thyroidectomy is 5-15%, with most being transient but some permanent. — Jason (epidemiological) [Ep 1 · 13:10](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=790)
- Among low-volume surgeons, hypoparathyroidism rate is approximately 5-15%, but this goes down to about 2.5% among high-volume surgeons—nearly a fivefold difference. — Jason (epidemiological) [Ep 1 · 13:30](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=810)
- Patients who underwent total thyroidectomy with central node dissection have much higher rates of recurrent laryngeal nerve palsy and transient or permanent hypocalcemia compared to those without central node dissection. — Jason (clinical) [Ep 1 · 14:00](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=840)
- Relative risk factors for recurrent laryngeal nerve injury include large tumor, non-visualized nerve, malignancy, nodal dissection, and redo operation. — Jason (clinical) [Ep 1 · 14:50](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=890)
- Overall statistics show approximately 0.3-1% risk of permanent recurrent laryngeal nerve injury in pediatric thyroidectomy patients, and 1-6% risk of transient palsy. — Jason (epidemiological) [Ep 1 · 15:10](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=910)
- Approximately 15% of children presenting with thyroid cancer already have nerve dysfunction at baseline before surgery. — Todd (epidemiological) [Ep 1 · 15:50](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=950)
- When parathyroid glands appear dusky intraoperatively, they should be biopsied; if there is red blood, leave them in place; if there is no red blood, remove and reimplant them. — Kurt (clinical) [Ep 1 · 27:12](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1632)
- Reimplanted parathyroid glands take about one month to return to function. — Kurt (clinical) [Ep 1 · 27:30](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1650)
- Intact parathyroid hormone (iPTH) should be measured in the recovery room and again at 6 and 8 hours postoperatively; if iPTH is less than 10, start vitamin D and calcium supplementation; if in the 30s, provide temporary supplementation expecting improvement. — Kurt (clinical) [Ep 1 · 27:30](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1650)
- Aggressive parathyroid reimplantation has dramatically dropped hypoparathyroidism rates in the speaker's practice. — Kurt (opinion) [Ep 1 · 26:40](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1600)
- Thyroid surgery guidelines have been rewritten four times in the last ten years, indicating rapid evolution of the field. (epidemiological) [Ep 1 · 28:54](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1734)
- Double-scrubbing (two attendings operating together) can maintain adequate case volume across a surgical group while keeping complication rates very low. — Kurt (opinion) [Ep 1 · 25:29](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1529)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Thyroid nodules are more common in adults than in children, so there are not many centers with pediatric surgeons who have high volume of these cases — Jill Knepprath summarizing the discussion [Ep 3 · 1:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=95)
- If biopsy comes back as cancer, completing thyroidectomy is the next recommended step — Jill Knepprath summarizing the discussion [Ep 3 · 1:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=116)
- In thyroid surgery, intraoperative nerve monitoring is a technique to localize the recurrent laryngeal nerves which control the vocal cords using an electric probe that stimulates the nerve while EMG electrodes monitor vocal cord movement — Jill Knepprath summarizing the discussion [Ep 3 · 2:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=130)
- In a recent survey, 80% of pediatric thyroid surgeons use nerve monitoring — Jill Knepprath summarizing the discussion [Ep 3 · 2:36](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=156)
- Nerve monitoring detects injury early, allowing surgeons to stage the operation and avoid bilateral injury, paralysis, and subsequent tracheotomy — Jill Knepprath summarizing the discussion [Ep 3 · 3:28](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=208)
- Nerve monitoring devices were often too big for pediatric patients in the past — Jill Knepprath summarizing the discussion [Ep 3 · 3:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=238)
- Nerve monitoring can be considered in all pediatric thyroid surgeries because adhesive electrodes can be applied to even a 3.0 endotracheal tube — Jill Knepprath summarizing the discussion [Ep 3 · 4:18](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=258)
- Radiologists say that TIRRADS is not really reliable for pediatrics since it was originally developed for adults — Jill Knepprath summarizing the discussion [Ep 3 · 4:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=290)
- When criteria was based on the size of the thyroid relative to the size of the patient, no malignancies were missed — Jill Knepprath summarizing the discussion [Ep 3 · 5:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=327)
- Dr. Aldrin's 2025 study showed that the PES-TIRRADS eliminated unnecessary biopsies while not missing a single thyroid malignancy compared to adult and 2015 pediatric guidelines — Jill Knepprath summarizing the discussion [Ep 3 · 5:33](https://qa.library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=333)
- The 2015 American Thyroid Association guidelines state that ultrasound characteristics of thyroid nodules are important for determining significance, not only size. — Jason summarizing the discussion [Ep 1 · 18:20](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1100)
- The 2015 American Thyroid Association guidelines state that fine needle aspiration (FNA) is an appropriate next step for thyroid nodules but must be done under ultrasound guidance. — Jason summarizing the discussion [Ep 1 · 18:40](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1120)
- The 2015 American Thyroid Association guidelines state there is not enough evidence in pediatrics to suggest that the character of specific thyroid cancer can predict outcomes or which patients should have certain treatments. — Jason summarizing the discussion [Ep 1 · 19:00](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1140)
- The 2015 American Thyroid Association guidelines recommend surgical resection (lobectomy) for any hyperfunctioning nodule, even after controlling hyperthyroidism. — Jason summarizing the discussion [Ep 1 · 19:40](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1180)
- The 2015 American Thyroid Association guidelines state that radioactive iodine ablation is not recommended across the board for low-risk patients (disease confined to thyroid or only incidentally found in surrounding lymph node), in contrast to standard practice for high-risk patients with metastatic disease or multiple bulky nodes. — Jason summarizing the discussion [Ep 1 · 20:00](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1200)
- The 2015 American Thyroid Association guidelines state that children with differentiated thyroid cancer should be taken care of at a center of excellence. — Jason summarizing the discussion [Ep 1 · 20:40](https://qa.library.globalcastmd.com/watch/pediatric-thyroid-disorders-update-course-2016-923?t=1240)

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