Background: Radioiactive iodine (RAI) treatment in low-risk pediatric patients with differentiated thyroid cancer (DTC) is still debatable. The objective of this study is to evaluate the outcome of treated and untreated patients in pediatric age. Materials and Methods: The data of all paediatric patients affected by ATA low-risk category DTC referred in the period 2010-2024 were retrospectively reviewed. Patients with DTC dimensions > 1.5 cm underwent to RAI. Demographic, clinical and biochemical data were analysed. Cytological category was assigned according to the Italian Society of Anatomical Pathology and Diagnostic Cytology (SIAPeC). Tumor, Nodes, metastases (TNM) classification system was used to assign the post-surgical class of risk. Results: All subjects were classified as low-risk and 7/14 (50%) were treated with RAI. Cytological categories after FNAB were TIR3b in 2/7 (28.6%) and TIR5 in 5/7 (71.4%) for RAI-treated patients, whereas TIR3b was observed in 6/7 (85.7%) and TIR5 in 1/7 (14.3%) in untreated patients ( p=0.03). T1 stage was assigned in 1/7 (14.3%) of patient treated with RAI, T2 stage was present in the remaining 6/7 (85.7%), whereas T 1 stage was opbserved in 6/7 (85.7%) and T2 stage in 1/7 (14.3%) of untreated patients ( p=0.007). No difference was observed regarding disease persistence or recurrence between treated and untreated patients. Conclusions: Considering the young age of children or adolescents with DTC, a case-by-case approach may be reasonable in subjects assigned to the low-risk category, rather than absolute recommendation for all patients.