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OBJECTIVES To provide a clinical disease state review of recent relevant literature and to generate expert consensus statements regarding the breadth of pediatric thyroid cancer diagnosis and care, with an emphasis on thyroid surgery. To generate expert statements to educate pediatric practitioners on the state-of-the-art practices and the value of surgical experience in the management of this unusual and challenging disease in children. METHODS A literature search was conducted and statements were constructed and subjected to a modified Delphi process to measure the consensus of the expert author panel. The wording of statements, voting tabulation, and statistical analysis were overseen by a Delphi expert (J.J.S.). RESULTS Twenty-five consensus statements were created and subjected to a modified Delphi analysis to measure the strength of consensus of the expert author panel. All statements reached a level of consensus, and the majority of statements reached the highest level of consensus. CONCLUSION Pediatric thyroid cancer has many unique nuances, such as bulky cervical adenopathy on presentation, an increased incidence of diffuse sclerosing variant, and a longer potential lifespan to endure potential complications from treatment. Complications can be a burden to parents and patients alike. We suggest that optimal outcomes and decreased morbidity will come from the use of advanced imaging, diagnostic testing, and neural monitoring of patients treated at high-volume centers by high-volume surgeons.

Objectives To provide a clinical disease state review of recent relevant literature and to generate expert consensus statements regarding the breadth of pediatric thyroid cancer diagnosis and care, with an emphasis on thyroid surgery. To generate expert statements to educate pediatric practitioners on the state-of-the-art practices and the value of surgical experience in the management of this unusual and challenging disease in children. Methods A literature search was conducted and statements were constructed and subjected to a modified Delphi process to measure the consensus of the expert author panel. The wording of statements, voting tabulation, and statistical analysis were overseen by a Delphi expert (J.J.S.). Results Twenty-five consensus statements were created and subjected to a modified Delphi analysis to measure the strength of consensus of the expert author panel. All statements reached a level of consensus, and the majority of statements reached the highest level of consensus. Conclusion Pediatric thyroid cancer has many unique nuances, such as bulky cervical adenopathy on presentation, an increased incidence of diffuse sclerosing variant, and a longer potential lifespan to endure potential complications from treatment. Complications can be a burden to parents and patients alike. We suggest that optimal outcomes and decreased morbidity will come from the use of advanced imaging, diagnostic testing, and neural monitoring of patients treated at high-volume centers by high-volume surgeons.

Expanding previous studies of human cerebral cortical sexual dimorphism showing higher neuronal densities in males, we investigated whether gender differences also exist in the extent of neuropil, size of neuronal somata, and volumes of astrocytes. This histo-morphometric study includes select autopsy brains of 6 males and 5 females, 12 to 24 yr old. In each brain, 86 defined loci were analyzed for cortical thickness, neuronal and astrocytic (8 loci) density (stereological counts), and neuronal and astrocytic (8 loci) soma size, enabling calculations of neuropil and astrocytic volumes. The female group showed significantly larger neuropil volumes than males, whereas neuronal soma size and astrocytic volumes did not differ. The expanded data confirmed higher neuronal densities in males than in females without a gender difference in cortical thickness. These findings indicate that fundamental gender differences exist in the structure of the human cerebral cortex, with more numerous, smaller neuronal units in men and fewer, larger ones in women; they may underlie gender-specific abilities and susceptibilities to disease affecting the neocortex. Laterality differences between the sexes were restricted to neuronal soma size showing significantly larger values in the female group in the left hemisphere. This gender difference may support female's right-handedness, language advantage, and tendency for bilateral activation patterns.