Purpose of the Review <p>The etiology of the increasing incidence of pediatric thyroid cancer is an open research question today. Clarification of the proximate cause of this data trend is critical to prevent progressive iatrogenic morbidity. Therefore, this review examines the discussion in current literature concerning the interpretation of the incidence data as well as surgical optimization strategies, for the purpose of reducing iatrogenic results.</p> Recent Findings <p>Diagnostic database research has shown that the incidence of pediatric thyroid cancer is on the rise both globally and in the USA, in parallel to adult figures. Two camps largely interpret the evidence as either primarily a result of overdiagnosis or as a mix of organic (though unclarified) and iatrogenic causes (including overdiagnosis). Additionally, the optimal risk-stratified surgical approach to balance the risks of both chronic iatrogenic morbidity and recurrence is debated, with current research indicating an opportunity for surgically de-escalated therapy in opposition to current guidelines.</p> Summary <p>Overdiagnosis is certainly implicated in these trends; however, there is concern and reasonable evidence that this is not the sole contributor. Professional consensus on the meaning of subclinical disease (in relation to definitions of overdiagnosis) is also critically needed for future research strategy. Additionally, present research suggests that prospective trials of surgically de-escalated therapy are warranted for well-selected pediatric thyroid patients.</p>