Introduction of the American Thyroid Association 2025 Thyroid Cancer Guidelines

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Differentiated thyroid cancer (DTC) includes papillary, follicular, and oncocytic carcinomas:
    • Comprising the vast majority (> 90%) of all thyroid cancers
  • In the United States:
    • It is estimated that there were 44,020 new cases of thyroid cancer in 2024:
      • Compared with 37,200 in 2015 when the last American Thyroid Association (ATA) guidelines were published
  • The yearly incidence tripled from 4.9 per 100,000 in 1975 to:
    • 14.3 per 100,000 in 2015
  • Approximately 25% of the new thyroid cancers diagnosed in 1988 to 1989 were < 1 cm:
    • Compared with 39% of the new thyroid cancer diagnoses in 2008 to 2009:
      • This shift to earlier detection / diagnosis correlates with the increasing use of neck ultrasonography and other imaging along with the advent of ultrasound-guided fine needle aspiration (FNA)
  • The incidence of thyroid cancer, and particularly small thyroid cancers:
    • Has reduced in the United States since 2014:
      • This change in incidence trajectory is likely a reflection of the adoption of guidelines’ recommendations from the ATA and other organizations discouraging FNA of small nodules < 1 cm in the absence of abnormal lymph nodes or local invasion:
        • Due to the overall outstanding prognosis associated with these tumors and weighed against the potential risks of unnecessary treatment
  • In addition to changes in the management of early-stage thyroid cancer:
    • Prior guidelines introduced criteria to enhance initial decision-making and a response framework following interventions to facilitate further management decisions:
      • These have been validated since the prior guidelines, enabling adoption in clinical practice
  • There have been major advances in understanding the molecular causes of thyroid cancer development and progression that have created newly approved treatment options for subsets of patients:
    • Published data in these and other areas require serial updates of existing guidelines to facilitate clinical care
  • In the current guidelines, an approach to clinical decision-making is introduced based upon the individual patient and clinician journey with thyroid cancer:
    • Which they term DATA:
      • Diagnosis
      • Risk / benefit Assessment
      • Treatment decisions
      • Response Assessment
  • This approach begins at the initial diagnosis of thyroid cancer, the diagnosis of residual disease or a clinical recurrence:
    • It includes assessment to determine whether a particular intervention is appropriate based on risks and benefits as well as individual patient factors:
      • When multiple possible management strategies are available, the framework supports identification of the best treatment option
  • Then, after intervention, an assessment of response using the 2025 ATA risk assessment tool is deployed to determine whether more treatment or monitoring is appropriate
  • The clinician and the patient can use this DATA framework to help make clinical decisions from diagnosis through the patient’s entire disease course.
Overall DATA framework for clinical management.
  • In 1996, the ATA published treatment guidelines for patients with thyroid nodules and DTC:
    • Over the last 25 to 30 years, there have been remarkable advances in knowledge affecting the diagnosis and treatment of DTC, but clinical controversy continues to exist in many areas
    • In the end, the goal is to provide individualized therapy for each patient based on the best application of clinical data to their unique case:
      • For example, a less aggressive approach would be recommended for individuals with early stage DTC who have an excellent prognosis or for individuals at higher risk of side effects, while a more aggressive approach would be recommended for those patients with higher risk disease or those with inadequate response to initial therapy
Rodrigo Arrangoiz, MD (Oncology Surgeon)
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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