In this episode, we review key updates from the 2025 American Thyroid Association guidelines on surveillance and radioactive iodine management for adult patients with differentiated thyroid cancer.

• Surveillance: Ultrasound as first line follow up; 6 to12 month intervals; FNA for nodes ≥10 mm; CT or PET for rising thyroglobulin without visible disease

• Radioactive Iodine: Not routine in low risk; recommended for high risk and metastatic cases; role in oncocytic thyroid carcinoma still uncertain

• Preparation for RAI Therapy: Recombinant TSH preferred; TSH goal greater than 30 mIU/L; low iodine diet before treatment

• Imaging: Pre and post therapy scans are essential

• Safety: Oral and written radiation precautions for patients and families

• Adverse Effects: Salivary gland dysfunction, xerostomia, and lacrimal duct problems, with hydration and preventive dental care recommended

• Takeaway: Ultrasound and thyroglobulin trends guide surveillance, RAI therapy should be tailored to patient risk, and careful preparation along with safety measures are critical for long term management