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. 2025 Aug 4;14(4):e250035.
doi: 10.1530/ETJ-25-0035. Print 2025 Aug 1.

Risk-adapted therapy in pediatric thyroid cancer: initial experience from a national reference program by the MET group

Michaela Kuhlen  1 , Marina Kunstreich  1   2 , Friederike Eilsberger  3 , Kerstin Lorenz  4 , Michael Abele  5 , Ines B Brecht  5 , Dominik T Schneider  6 , Markus Luster  3 , Antje Redlich  3
Affiliations

Risk-adapted therapy in pediatric thyroid cancer: initial experience from a national reference program by the MET group

Michaela Kuhlen et al. Eur Thyroid J. .

Abstract

Background: Pediatric differentiated thyroid carcinoma (pedDTC) is rare but increasingly prevalent, requiring multidisciplinary care to ensure optimal outcomes. In 2021, the pediatric national reference program of the German Malignant Endocrine Tumor (MET) registry was established to standardize the management of pedDTC, with a particular focus on radioactive iodine (RAI) use and minimizing treatment variability.

Methods: This study evaluated the program's first 3.5 years, including 43 inquiries concerning 39 patients with confirmed or suspected pedDTC. A weekly national expert tumor board provided individualized recommendations based on multidisciplinary input and risk stratification. Data were analyzed for demographic trends, therapeutic decisions, and short-term outcomes.

Results: Among 34 patients with confirmed pedDTC, RAI use was reduced or omitted in 70.6% of cases, particularly among low-risk patients, in alignment with the American Thyroid Association 2015 guidelines. Surgical strategies were modified in 61.5% of cases to balance disease control with treatment-related morbidity. No systemic medical therapy was recommended during initial management. At a mean follow-up of 0.7 years, all patients were alive; persistent disease was observed in 15.4%.

Conclusions: The national reference program has successfully introduced a structured, individualized approach to the management of pedDTC in Germany. Ongoing data collection and longer follow-up will be essential to assess the long-term impact of this centralized, risk-adapted model.

Keywords: children and adolescents; differentiated thyroid carcinoma; radioactive iodine therapy; reference program.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the work reported.

Figures

Figure 1
Figure 1
Recommendations for RAI therapy, surgical strategies, systemic therapies, and diagnostics (outer circle) in comparison to the approach initially suggested by the referring physician (inner circle).
Figure 2
Figure 2
Increase in inquiries over time.
See this image and copyright information in PMC

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