The optimal treatment of children with papillary thyroid cancer (PTC) is debated but usually includes surgery, radioactive iodine (RAI), and thyroid hormone. With such treatment, the mortality rate is low (<12% in contemporary studies), but recurrence rates are high (≤39%). We previously reported 19.7% recurrence in a cohort of 137 patients diagnosed with PTC at≤21 yrs of age. By multivariate analysis, multifocal disease (>1 histologically proven site within the thyroid, 42% of our patients) was the most significant factor predicting recurrence. Based on these data, we hypothesized that patients with unsuspected multifocal disease, treated with lobectomy ± isthmusectomy, would have a greater risk of recurrence than similar patients treated with more extensive surgery. To test this hypothesis, we examined the records of 39 patients with Class 1 disease (negative lymph node examination and disease confined to the thyroid gland). We analyzed the frequency of recurrence with respect to the type of surgery and treatment with RAI. Eight patients developed recurrence (6 local, 2 distant, median follow up 55 mos). Patients treated with subtotal or total thyroidectomy had a lower risk of recurrence compared to patients treated with lobectomy ± isthmusectomy (p=0.043, linear-by-linear association). The majority of patients received both RAI and thyroid hormone (70% of patients without recurrence vs 50% with recurrence, p=NS). These data suggest that total or subtotal thyroidectomy should be the initial surgical procedure in children with Class 1 papillary thyroid cancer. The numbers are too small to determine if RAI adds additional benefit. Table

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