AACE MENA 2025-Updated Thyroid Nodule and Cancer Guidelines, An Endocrine Surgeon’s Perspective

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Video Summary

Dr. Julianne presents the 2025 American Thyroid Association guidelines on differentiated thyroid cancer (DTC), emphasizing a patient-centered, evidence-based approach that marks significant changes from prior protocols. Unlike 2015 guidelines, the new framework follows the patient journey starting from diagnosis through assessment, treatment options—including active surveillance and percutaneous ablation—and reassessment, acknowledging patients may cycle through management phases over decades.<br /><br />Key updates include expanding management beyond immediate surgery for low-risk papillary thyroid microcarcinoma, with conditional recommendations now supporting active surveillance or ablation. Thyroid lobectomy remains preferred for tumors ≤2 cm; total thyroidectomy is less favored except when patient preference or pathology indicates. Prophylactic central lymph node dissection is generally discouraged for small, node-negative tumors. Postoperative monitoring now allows de-escalation for low-risk patients in complete remission, with less reliance on thyroglobulin levels without radioactive iodine treatment due to variable reliability.<br /><br />For high-risk patients, comprehensive imaging and aggressive surgery remain standard. Molecular testing is reserved for advanced cases with recurrent or radioiodine-resistant disease to guide targeted therapies, exemplified by a case responding well to selpercatinib after RET fusion identification.<br /><br />Dr. Julianne stresses shared decision-making tailored to individual risk profiles and patient preferences, embracing change guided by evolving evidence to improve outcomes in endocrine oncology.

Keywords

American Thyroid Association 2025 guidelines

differentiated thyroid cancer

patient-centered approach

active surveillance

thyroid lobectomy

molecular testing

shared decision-making