Whilst 5% of nodules in adults may harbour malignancy it is reported in this review that about a quarter of nodules may do so in children. Malignancies in this group are almost always well-differentiated subtypes of papillary, follicular and medullary carcinoma. Radiation has been implicated with the risk increasing with increasing exposure, and the well-established genetics of multiple endocrine neoplasia (MEN) is described. Aside from MEN there is an increased risk in other syndromes including Cowden, Gardner, Peutz-Jeghrs and familial adenomatous polyposis, most of which are autosomal dominant. All solid thyroid nodules greater than 1cm in size should undergo a needle aspiration for cytology, smaller nodules only in the presence of other suspicious features. Once identified, nodules should undergo surveillance if a conservative course is followed. A useful algorithm for nodules in the paediatric population is presented along with unusual presentations either ectopic or in congenital cysts. A helpful description of methodology to monitor the recurrent laryngeal nerves is also described, in particular alternatives given the smallest endotracheal tube with monitoring electrodes is likely too big for almost all children. It should be noted in this review that quoted articles include ages up to 21.