In this episode, we review key updates from the 2025 ATA guidelines on surgical referral, imaging, and risk based management for adult patients with differentiated thyroid cancer.

• Referral to high volume thyroid surgeons (≥25 to 50/year) for better outcomes

• Comprehensive neck ultrasound; FNA for suspicious nodes ≥8 to 10 mm

• Use CT or MRI if ultrasound is insufficient for invasive or bulky disease

• Avoid routine preoperative thyroglobulin, antibody testing, and genomic profiling unless it informs surgical planning

• Active surveillance for very low risk papillary thyroid cancers (≤1 cm, intrathyroidal)

• Percutaneous ablation as an alternative for select low risk patients

• Indications for surgery: tumor growth ≥3 mm, nodal metastases, extrathyroidal extension, or patient preference