Thyroid Cancer in Children The American Cancer Society esti-

mates that 67,200 new cases of thyroid cancer were diagnosed in the United States in 2013 (1). The median age at diagnosis for all patients is 50 y, with less than 2 % of occurrences being in patients younger than 20 y (2). Thyroid cancer is 10-fold more common in adolescents than in younger children. Because the expected number of adolescents (ages 15–19 y) in the United States with new diagnoses of thyroid can-cer in 2014 is approximately 570 (3), we should anticipate about 625 new thyroid cancer diagnoses in children and adoles-cents combined, with about 90 % being dif-ferentiated thyroid cancer (DTC) (4). This incidence compares with expected inciden-ces of about 700 for neuroblastoma (3), 400 for osteosarcoma (5), and 350 for rhabdomyosarcoma (6). See page nnn There have been major advances in the treatment results for most solid malignan-cies of childhood although cure rates re-main suboptimal, particularly for those with advanced disease. DTC, however, has been associated with high survival rates in children for more than 30 y. Since 1975, the 5-y survival rates of adolescents with thyroid cancer have ranged from 97.5 % to 99.6 % (7). Only 0.1 % of thyroid cancer deaths occur in patients younger than 20 y. Despite high survival rates, pe-diatric patients with DTC frequently pre-sent with regional cervical lymph nodal metastases and distant metastatic disease, most commonly involving the lungs. Such patients require an aggressive treatment approach consisting of total thyroidectomy and excision of all surgically accessible local-regional metastatic deposits, followed by administration of one or more courses of 131I therapy. The Children’s Oncology Group has no treatment studies for thyroid cance