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This systematic review comprehensively examines the pathogenesis, diagnosis, management, and cancer risk of Hashimoto's thyroiditis in pediatric populations. We searched the literature using PubMed, Web of Science, and critical medical journals, focusing on studies published within a specified timeframe. Inclusion criteria targeted studies on pediatric populations, while exclusion criteria filtered out irrelevant studies. Data extraction and synthesis highlighted key findings: genetic predispositions and environmental triggers such as selenium levels and gut microbiota alterations contribute to Hashimoto’s Thyroiditis pathogenesis. Diagnostic challenges arise from the often subtle and nonspecific clinical presentation, necessitating thorough clinical evaluations and diagnostic testing, including TSH, free T4, thyroid antibodies, and ultrasound. Management strategies involve levothyroxine therapy, dietary considerations, and lifestyle modifications tailored to individual patient needs. Additionally, the review discusses the controversial but significant potential association between Hashimoto’s Thyroiditis and increased thyroid cancer risk, emphasizing the need for vigilant long-term monitoring. This synthesis provides critical insights to inform clinical practice and future research directions.