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Adults with Differentiated THyroid Cancer - 2025 Update

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39 RISK OF RECURRENCE HIGH >30% INTERMEDIATE– HIGH ≥16–30% LOW– INTERMEDIATE 10–15% LOW <10% T3a + microscopic ETE, T3b, or T4; or ANY T with any of the following: Poorly differentiated or high grade Widely invasive Encapsulated angioinvasive: extensive vascular invasion ≥4 vessels cN1 ≥3 cm b Extranodal extension (ENE) Distant metastasis (M1) T1, T2, or T3a with any of the following: Clinically evident lateral LN mets (cN1b) <3 cm b 2+ Low-intermediate risk factors T3a or; T1 or T2 with any of the following: Microscopic ETE Limited vascular invasion <4 vessels c cN1a or pN1a >2 mm a or >5LNs b Negative margins or microscopic + posterior margin (R1) T1 or T2 (≤4 cm): Minimally invasive: capsular invasion only c pN0a, or cN0 and pN1a (≤5 LNs, all ≤2 mm) b Negative margins or only microscopic + anterior margin (R1) Estimated risk of recurrence up to 10 years LEGEND: a No clear cutoffs for LNs between low-intermediate and high-intermediate risk groups. In general, smaller size and fewer lymph node metastases are associated with lower risk of recurrence. b Lymph node metastases are uncommon in OTC and FTC/IEFVPTC. c WHO 2022 definition. OTC c

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