Pediatric thyroid carcinoma accounts for approximately 1.8% of all thyroid malignancies in the United States, 3% of all pediatric malignancies. Despite that, it is only within the past 5-10 years that any pediatric specific guidelines have been developed for the evaluation and management of these patients. While the previously reported guidelines are a good starting point, they are not yet well developed due to the relative infrequency of pediatric disease relative to adult disease and the disparate approaches to treatment among institutions. Additionally, patients often present with advanced disease that makes it difficult to follow the currently available guidelines. This mini seminar will be an interactive session utilizing the expertise of Pediatric Otolaryngologists and Head and Neck Surgeons who have a high-volume thyroid practice and are engaged members of the AHNS Pediatric Endocrine Committee, to discuss advanced pediatric thyroid carcinoma patients that do not fit the previously reported guidelines. The panelists will demonstrate how utilizing a multi-disciplinary approach can improve treatment outcomes and what outcome measures need to be monitored to continue to develop treatment pathways for even the most advanced disease. The panelists will discuss pitfall they encountered when treating these patients and the steps necessary to avoid them in the future. Finally, the panelists will discuss how the newly developed AACE/AHNS guidelines impact treatment recommendations for advanced disease.