With the first guidelines for the management of pediatric thyroid nodules and differentiate thyroid cancer from the American Thyroid Association in 2015 and the recent AACE/AHNS consensus statement on pediatric benign and malignant thyroid surgery released in 2020, there are increasing guidance for the management of thyroid nodules and cancer in children. However, the recommendations are aimed more at the initial evaluation and management of nodules and RAI responsive differentiated thyroid cancer. There is a paucity in information and guidance for the management of pediatric patients that present with morbidly advanced disease or that develop progressive, RAI refractory thyroid cancer. In an article published in JAMA-OTO (July 2020), a recommendation was made to consider a paradigm shift in the care for these patients using oral, systemic chemotherapy, either tyrosine kinase inhibitors and/or oncogene specific targeted therapy, to reduce surgical and medical morbidity and improve outcome. This program will be comprised of a panel to discuss the management of advanced or recurrent thyroid cancer. The use of systemic therapy as well as both surgical and non-surgical modalities for invasive thyroid cancer in children and adolescents shall be presented.