Illuminating pediatric thyroid cancer From consensus to surgical innovation

Differentiated thyroid cancer (DTC) in children, adolescents, and young adults is rare, and data on optimal treatment regimens and long-term oncological outcomes remain limited. The disease is characterized by excellent survival but a substantial risk of recurrence and treatment-related morbidity. The lack of standardized outcome definitions and the high incidence of postoperative complications represent two major challenges in improving its surgical management. This thesis aims to improve the surgical management of (pediatric) DTC by identifying and defining its key outcomes and by reducing its complications, ultimately enhancing patient outcomes. The work is structured into three parts.
In the first part, the long-term oncological outcomes of children and AYAs with DTC are described in national cohorts, along with their tumor characteristics and the treatment regimens employed. These studies provide context for understanding disease behavior and outcomes across age groups.
The second part focuses on establishing global key outcomes and definitions of complete remission and recurrence for research and clinical practice in the surgical treatment of DTC, through a systematic review and two international Delphi consensus studies.
The third part addresses postoperative complications following pediatric thyroid cancer surgery, with emphasis on postoperative hypocalcemia as the most prevalent adverse outcome. It further evaluates the feasibility of quantified intraoperative fluorescence imaging of the parathyroid glands in children, as an initial step toward improving intraoperative assessment of parathyroid perfusion and ultimately reducing the risk of postoperative hypocalcemia in this population.
Together, this thesis contributes to improved standardization of outcome assessment and introduces innovative methods to reduce treatment-related morbidity in children, adolescents, and young adults with DTC.