Behind The Knife: The Surgery Podcast11 Touko

Journal Review in Endocrine Surgery: Updates of the 2025 American Thyroid Association Guidelines for Differentiated Thyroid Cancer

What are the experts saying about thyroid cancer treatment in 2025? Maybe it’s time to discuss deescalation of aggressive surgical care for lower risk thyroid cancers. We can accept that less surgery may be appropriate in select cases, including more thyroid lobectomies versus total thyroidectomies, consider less invasive approaches such as percutaneous ablation techniques, and utilize more observation with active surveillance. Early assessment of treatment may allow appropriate reduction in use of radioactive iodine ablation and more relaxed routine monitoring can reduce surveillance burden to patients and providers.

Hosts:
- Amanda Doubleday, DO, MBA, Assistant Professor, Waukesha Surgical Specialists, ProHealth Care. Affiliated with University of Wisconsin School of Medicine and Public Health, Department of Surgery.
- Simon Holoubek, DO, MPH, Assistant Professor, University of Wisconsin School of Medicine and Public Health, Department of Surgery.
- Alexander Chiu, MD, Assistant Professor, University of Wisconsin School of Medicine and Public Health, Department of Surgery.
- Rebecca S Sippel, MD, FACS, Professor and Chair of Division of Endocrine Surgery, Vice Chair of Academic Affairs and Professional Development, University of Wisconsin School of Medicine and Public Health, Department of Surgery.

Learning Objectives:
- Risk stratification system now includes 4 categories: low, low-intermediate, high-intermediate, and high
-TSH suppression targets are simplified: below the normal range if there is structural or biochemical disease and in the normal range if disease free.
- Thyroid lobectomy is recommended for tumors < 2cm cT1N0 tumors and can be considered for tumors 2-4 cm.
- Micro-Papillary Thyroid Carcinoma (<1cm) can be managed with active surveillance and/or percutaneous ablation
- Central compartment lymph node dissection includes levels 6-7.
- RAI is strongly not recommended for low risk cancers. Can be considered in low-intermediate and high-intermediate cancers. It is routinely recommended in high risk cancers.

References:
Ringel MD, Sosa JA, Baloch Z, Bischoff L, Bloom G, Brent GA, Brock PL, Chou R, Flavell RR, Goldner W, Grubbs EG, Haymart M, Larson SM, Leung AM, Osborne JR, Ridge JA, Robinson B, Steward DL, Tufano RP, Wirth LJ. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid. 2025 Aug;35(8):841-985. doi: 10.1177/10507256251363120. Erratum in: Thyroid. 2025 Nov;35(11):1350. doi: 10.1177/10507256251387671. PMID: 40844370.
https://pubmed.ncbi.nlm.nih.gov/40844370/

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