A cold thyroid nodule is a hypofunctional lesion that does not fix the radioisotope to scintigraphy. The risk of its malignancy is estimated at 30%. This is a retrospective study of 5 cases operated at the visceral pediatric surgery department “A” of the Children's Hospital of Rabat from 2004 to September 2017. Our main objective is to discuss the difficulties of diagnosis of certainty in front of the child’s cold thyroid nodule and to evaluate the modalities of its surgical management while comparing the results of our study with those of the literature. The average age of our patients was 11 years, with a sex ratio F/M of 0,6. Most of our patients consulted for a thyroid nodule, associated in 20% of cases with cervical lymphadenopathy, and in 20% to signs of compression. Thyroid scintigraphy favored a cold nodule in 100% of cases. Thyroidectomy was indicated in 80% of cases, followed by lymph node dissection in 40% of cases. The diagnosis of certainty of a cold thyroid nodule was based on the anatomopathological examination of the operative specimen, which showed papillary carcinoma in 60% of cases, atypical follicular carcinoma in 20% and a cyst of thyreogloss tract in 20%. Radioactive iodine 131 treatment was performed in 60% of cases. Subsequently 60% of our patients were put on thyroid hormone therapy. The medium-term evolution was favorable in 80% of the cases. Local recurrence was detected in 20% of cases. A well-conducted surgical procedure, followed by an iratherapy, optimizes the therapeutic effectiveness which can be close to 100% even in case of metastases.