Pediatric differentiated thyroid cancer (DTC) presents unique challenges distinct from its adult counterparts, including higher rates of multifocality, regional lymph node involvement, and distant metastases. This article reviews the latest advancements and controversies in the surgical management, postoperative care, and long-term surveillance of pediatric DTC, emphasizing the importance of a tailored approach based on individual risk assessments. The evolving landscape of treatment strategies aims to balance the imperative of effective cancer control with the need to mitigate long-term adverse effects and ensure quality of life. The review also highlights the critical need for ongoing research and multidisciplinary collaboration to refine and optimize management protocols for this vulnerable population.