Updated Dutch 2026 pediatric differentiated thyroid carcinoma guideline: aligning with Europe

Area of Science:

• Pediatric Endocrinology
• Oncology
• Genetics

Background:

• Pediatric differentiated thyroid carcinoma (DTC) is rare, posing challenges for standardized European care.
• The Netherlands' 2020 national DTC guideline required reconciliation with the 2022 European Thyroid Association (ETA) guideline.
• This article details the 2026 update of the Dutch guideline, harmonizing European and national practices.

Purpose of the Study:

• To update the Dutch national guideline for pediatric differentiated thyroid carcinoma (DTC).
• To reconcile the 2020 Dutch guideline with the 2022 European Thyroid Association (ETA) recommendations.
• To incorporate context-specific adaptations into the national DTC management framework.

Main Methods:

• Systematic comparison of the 2020 Dutch guideline with the ETA 2022 guideline.
• Discussion of identified differences by a national pediatric DTC working group.
• Consensus meeting to agree on revisions and context-specific adaptations for the Dutch setting.

Main Results:

• Adoption of most European recommendations with key national adaptations.
• Specific protocols for Bethesda V-VI nodules with BRAF mutation, including total thyroidectomy without prior histology.
• Expanded use of molecular diagnostics and genetic counseling referrals.
• Recommendations for less extensive surgery and selective omission of radioactive iodine therapy based on shared decision-making.
• Streamlined follow-up with neck ultrasound limited to initial 3-month assessment unless indicated.

Conclusions:

• The 2026 Dutch guideline achieves alignment with European recommendations while retaining essential national adaptations.
• Provides a framework for consistent, patient-centered pediatric DTC care in the Netherlands.
• Serves as a model for harmonized pediatric DTC management across Europe.