What is the Optimal Operative Approach for DTC RECOMMENDATION 15 from the ATA 2025 Guidelines

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • When resection is performed for patients with thyroid cancer ≤ 2 cm without gross extra-thyroidal extension (cT1) and without metastases (cN0M0):
    • The initial surgical procedure should be a thyroid lobectomy:
      • Unless there are bilateral cancers or other indications to remove the contralateral lobe:
        • Strong recommendation, Moderate certainty evidence
  • For patients with low risk, unilateral thyroid cancer > 2 and ≤ 4 cm (cT2N0M0):
    • Thyroid lobectomy may be the preferred initial surgical treatment due to significantly lower risk and side effects:
      • However, the patient and treatment team may adopt total thyroidectomy to enable RAI administration and / or enhance follow-up based on disease features, suspicious contralateral nodularity, and / or patient preferences
    • When thyroid lobectomy is offered as initial treatment, counsel the patient about the possibility of conversion to total thyroidectomy or need for subsequent completion thyroidectomy if higher-risk factors emerge intraoperatively or postoper-
      atively:
      • Conditional recommendation, Low-moderate
        certainty evidence
  • For patients with thyroid cancer > 4 cm (cT3a), cancer of any size with gross extra-thyroidal extension (cT3b or cT4), or clinically apparent metastatic disease to lymph nodes (cN1) or distant sites (cM1):
    • The initial surgical procedure should include a total thyroidectomy with gross removal of all primary tumor and node dissection unless there are contraindications to this procedure
      • Strong recommendation, Moderate
        certainty evidence
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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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