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

Background: Pediatric differentiated thyroid carcinoma (DTC) is a rare disease, creating challenges for standardized care across Europe. The Netherlands published its first national pediatric DTC guideline in 2020. The 2022 European Thyroid Association (ETA) guideline introduced differences that required reconciliation with national practice. This article presents the 2026 update of the Dutch guideline, harmonized with European recommendations while retaining context-specific adaptations. Methods: The 2020 Dutch guideline was systematically compared with the ETA 2022 guideline. Differences were discussed by the national pediatric DTC working group and addressed in a structured consensus meeting to agree on revisions and adaptations relevant to the Dutch context. Results: Most European recommendations were adopted. Key national adaptations include performing total thyroidectomy without prior histology in Bethesda V-VI nodules with a proven BRAF mutation, expanded use of molecular diagnostics in selected nodules, and referral for genetic counseling in confirmed cases. In addition, less extensive surgery and selective omission of radioactive iodine therapy in low-risk patients were recommended, based on shared decision-making. Follow-up with neck ultrasound was limited to an initial 3-month assessment, with subsequent imaging only in case of rising thyroglobulin or anti-thyroglobulin concentrations. Conclusions: The 2026 Dutch guideline aligns with European recommendations while preserving context-specific adaptations. It provides a framework for consistent, patient-centered care and supports standardized clinical practice in the Netherlands, offering a model for harmonized pediatric DTC management across Europe.