Pediatrics Papillary Thyroid Carcinoma: A 14-Year Experience in Surgical and Nuclear Medicine Management at a Portuguese Oncology Centre

Purpose Radioiodine therapy (RAIT) remains an essential tool in both treatment and restaging of pediatrics papillary thyroid carcinoma (PTC). Our aim was to describe clinical, surgical, and nuclear medicine management outcomes of pediatrics PTC patients over a 14-year period, emphasizing the role of RAIT in post-surgical treatment and restaging. Methods A retrospective observational study was conducted at a reference Oncological Institute, including 35 pediatrics patients (< 18 years) diagnosed with PTC between 2010 and 2023. Demographic data, staging features, risk factors, surgical treatment, RAIT therapy, post-therapy scintigraphy, adverse effects, and follow-up outcomes were reviewed. Results Among the 35 patients (mean age 15; 77% female), 54% had one or more risk factors, most frequently family history. Sixteen individuals presented low-risk disease, 12 had intermediate-risk characteristics, and 7 were classified as high-risk patients (according to ATA guidelines). Twenty-eight underwent total thyroidectomy (7 with lymphadenectomy), and the remaining received a hemithyroidectomy. Following thyroidectomy, twelve patients (all low-risk) were managed exclusively with clinical follow-up, without further directed treatment, while twenty-three patients received RAIT, with a mean dose of 3.5 GBq. Post-therapy imaging revealed previously undetected pulmonary metastases in 4 patients (17%), leading to disease upstaging. RAIT treatment resulted in complete remission in three of these cases. Adverse effects were mild and easily managed with symptomatic medication. After a mean follow-up of 9 years, no recurrences were reported, all patients were alive, and no long-term side effects were reported. Conclusion This study supports the safety and utility of RAIT in pediatrics PTC for both treatment and restaging. Post-therapeutic scintigraphy remains a valuable diagnostic step in identifying unsuspected distant metastases. Our long-term results confirm excellent survival with favourable toxicity profiles in a multidisciplinary management approach.