14
Treatment
Recommendation 28
A. The 2025 ATA Risk Stratification System, which evaluates the
histopathologic features of the tumor and number of cervical lymph
nodes in combination with the AJCC staging system, postoperative
imaging, and serum Tg and TgAb testing (if appropriate) is
recommended to determine the risk of structural disease
persistence/recurrence (locoregionally and/or distantly) and/or
survival in patients with DTC. (S-M)
B. Molecular profiling of histologic specimens postoperatively is not
recommended routinely. However, if such data have been obtained,
they can be used to further estimate risks of recurrence derived from
the 2025 ATA Risk Stratification System. (C-L)
Recommendation 29
➤ The ATA Response Criteria should be used to categorize response to
surgery prior to determining intensity of additional therapy or monitoring
in combination with the ATA Risk of Recurrence Estimates. (S-M)
Recommendation 30
A. Measuring a postoperative serum Tg level six to 12 weeks after
total thyroidectomy while on thyroid hormone therapy or after
TSH stimulation is recommended. Such measurements may guide
additional decision-making regarding clinical management. (S-L)
B. Measurement of serum Tg on one occasion six to 12 weeks after
thyroid lobectomy with a normal TSH may be helpful to ensure that
it is not unexpectedly elevated; however, a specific cut-off value is
uncertain. (GPS)
Recommendation 31
A. Ultrasound to evaluate the thyroid bed and central and lateral
cervical lymph node compartments is the preferred method of
imaging surveillance for most DTC. (S-M)
B. If the serum Tg level after surgery is above the excellent response
range (see Table 9), and/or there are Tg Ab, cervical ultrasound
and/or cross-sectional imaging should be performed prior to
administering RAI. (GPS)
C. Six to 12 months following completion of initial therapy, cervical
ultrasound to evaluate the thyroid bed and central and lateral
cervical lymph node compartments should be performed. Timing
and frequency thereafter are informed by the patient's risk for
residual or recurrent disease and response to therapy. (GPS)
