12/07/2025
Loved seeing Dr. Michael Tuttle again. He remains, to me, one of the most innovative and inquisitive thyroid experts—continually generating ideas that move the field forward.
A few bullet points from the new guidelines from the American Thyroid Association for management of Differentiated Thyroid Cancer:
1) Modify total thyroidectomy (removing all the gland) versus lobectomy (removing half of the gland), for tumor size >4 cm as an automatic indication for total thyroidectomy in certain pathways.
2) Emphasizes that active surveillance for low risk thyroid cancer is recommended -patients who present with small (≤4 cm) papillary thyroid cancers and have negative margins, no contralateral lesions, and no suspicious lymph nodes after lobectomy.
Now, disease monitoring is sufficient for this patients
3) Patients with low risk for recurrence, and as had previously normal neck ultrasound, and had biochemically excellent response may NOT require long-term ultrasound follow-up and we may use the term in “complete remission”
4) Targeted therapies are now preferred for RAI-refractory differentiated thyroid cancer and medullary thyroid carcinoma. Lenvatinib is the preferred systemic therapy for RAI-refractory differentiated disease
5) Surveillance protocols emphasize measuring TSH, thyroglobulin (Tg), and Tg antibodies using the same laboratory and assay for consistency. Rising or new Tg antibodies or abnormal imaging should trigger escalated follow-up with biopsy of suspicious areas.
