Approximately 10% to 20% of pediatric patients with papillary thyroid carcinoma (PTC) will have distant metastases. Proper risk stratification of children with PTC is important to optimize treatment. In 2015, the American Thyroid Association (ATA) published guidelines for the management of children with PTC. Data from the Surveillance, Epidemiology, and End Results (SEER) populationbased database were used to describe the characteristics and outcomes of children and adolescents with PTC who were classified as high-risk per the ATA guidelines. Using SEER 18, we analyzed patients less than 20 years of age with PTC diagnosed between 2004 and 2014. TNM staging was used to categorize patients into the ATA pediatric high-risk group, which included patients with either locally invasive tumors (T4) or distant metastatic disease (M1). Of 1861 patients with PTC, 110 (6%) were identified as high-risk. Seventy-six patients had T4 disease and 54 patients had M1 disease; 20 of those patients had both. Eighty (73%) patients were female. Sixty-two (56%) patients were between 15 and 19 years old at diagnosis and 39 (35%) were between 10 and 14 years. Fifty-nine (54%) patients were non-Hispanic White, 33 (30%) were Hispanic, 6 (5%) were nonHispanic Black, and 12 (11%) were other. Ninety percent of the patients underwent a total thyroidectomy and 6% underwent a near total thyroidrectomy. A total of 96 (87%) patients received irradiation. Two patients died secondary to their thyroid malignancy within 5 years after diagnosis. Despite having widespread disease, pediatric and adolescent patients with high-risk PTC per ATA classification have an excellent prognosis. Major limitations of this study are the lack of recurrence data and inability to distinguish high-risk nodal disease in the SEER database. Prospective research is warranted to study long-term outcomes and side effects of radiation.
