Pediatric thyroid cancer: Distinct pathogenesis, emerging therapeutic strategies and long-term survivorship management.

Pediatric thyroid cancer is the most common endocrine malignancy in children and represents a distinct clinical entity compared with adult disease. Although children frequently present with advanced-stage disease, they typically achieve excellent long-term outcomes. This paradox creates a central therapeutic challenge: maximizing oncologic control while minimizing the lifelong consequences of overtreatment. This review aims to synthesize the evolving management paradigm for pediatric thyroid cancer, with a dual focus on implementing precision oncology for advanced disease and safely de-escalating therapy to preserve survivorship. We detail the disease's rising incidence, unique molecular pathogenesis dominated by gene fusions, and the consequent need for pediatric-specific risk stratification. The review critically examines current evidence for risk-adapted surgery, refined use of radioactive iodine, and molecularly targeted therapies. By integrating advances in molecular stratification, targeted therapy, and survivorship science, this review provides a framework for navigating the central challenge of balancing cure with quality of life. This synthesis underscores the imperative to transition from adult-centric treatment paradigms to a risk-adapted, lifespan-oriented approach, thereby guiding the development of evidence-based, precision management strategies for this unique population.