Composition and Priorities of Multidisciplinary Pediatric Thyroid Programs: A Consensus Statement

CLINICAL QUESTION

What are the essential components and priorities of multidisciplinary pediatric thyroid programs to ensure optimal care and outcomes?

BOTTOM LINE

These consensus statements outline key components of multidisciplinary pediatric thyroid programs that should be consistent across institutions. Implementing this model may standardize care, improve health outcomes, support research, and foster collaboration in pediatric thyroid disease management.

BACKGROUND: Pediatric thyroid cancer is rising in incidence, with care often varying due to socioeconomic disparities and practice differences. Clinical guidelines recommend multidisciplinary team-based care to standardize management. This study aims to define the structure and function of such teams based on expert consensus.

STUDY DESIGN: A modified Delphi method was conducted over two rounds, in which 21 multidisciplinary experts rated statements on a 9-point Likert scale. Responses were reviewed and refined between rounds to reach consensus, determine lack of consensus, or maintain unchanged statements.

SETTING: This international consensus study involved pediatric thyroid content experts selected for their clinical experience, academic contributions, and leadership roles. Surveys were developed and administered via an online platform (Welphi.com), and consensus was reached using the modified Delphi method. The study was conducted under the Stanford Medicine Center for Improvement guidelines.

SYNOPSIS: This consensus study engaged 24 multidisciplinary experts (88% response rate in Round 1, 83% in Round 2) across pediatric endocrinology, surgery, otolaryngology, nuclear medicine, oncology, and other specialties to define essential components of pediatric thyroid programs. Using two rounds of a modified Delphi survey, 66 items were assessed, resulting in consensus for 29 items, near consensus for 7, and no consensus for 25. Experts strongly agreed that pediatric thyroid centers should care for patients with differentiated thyroid cancer (DTC), medullary thyroid cancer (MTC), thyroid nodules, and genetic tumor syndromes. The panel emphasized that thyroid cancer care in children is distinct from other noncancerous thyroid conditions. However, no consensus was reached on a specific upper age limit for pediatric care, though flexibility up to age 21 was supported. Core team members identified included a pediatric endocrinologist, an experienced thyroid surgeon, an expert in ultrasound-guided fine needle aspiration, and specialists in radiology, nuclear medicine, pathology, genetics, and psychosocial care. Multidisciplinary coordination and care conferences were seen as essential services. Top research priorities included the development of national/ international care guidelines, long-term treatment toxicity, and patient-reported outcomes.

CITATION: Kothari R, et al. Composition and priorities of multidisciplinary pediatric thyroid programs: a consensus statement. Thyroid. 2025;35:346-356. doi:10.1089/thy.2024.0496

COMMENT: This is a recent Delphi method article on expert opinion to describe the form and function of what a multidisciplinary pediatric thyroid program should look like. Over the last two decades, it has become increasingly acknowledged that pediatric thyroid cancer patients have distinct differences compared to adults. This article emphasizes agreement among experts that a comprehensive team includes, but is not limited to, a thyroid surgeon, a pediatric endocrinologist, a high-volume fine needle aspiration proceduralist, an oncologist, a nuclear medicine physician, a pediatric pathologist, a pediatric radiologist, and a nurse coordinator.—Ryan Belcher, MD, MPH