Modern Surgical Approaches in Differentiated Thyroid Cancer: From ATA 2015 to ATA 2025

Abstract

The transition from the American Thyroid Association (ATA) 2015 to 2025 guidelines for differentiated thyroid cancer (DTC) reflectS a paradigm shift toward personalized, risk-adapted surgical strategies. Recent evidence supports thyroid lobectomy as an adequate treatment for selected low-risk patients with small, intrathyroidal tumors, offering comparable oncologic outcomes to total thyroidectomy, with reduced complication rates and improved quality of life. Conversely, total thyroidectomy remains essential in high-risk disease, including large tumors, extrathyroidal extension, nodal metastases, or aggressive histological variants, and when radioactive iodine therapy is indicated. The 2025 ATA guidelines further refine intermediate-risk stratification and incorporate selective use of molecular profiling, including mutations such as BRAF and TERT, to guide surgical extent. Lymph node management emphasizes therapeutic rather than prophylactic dissection to minimize morbidity. Overall, modern surgical approaches prioritize oncologic safety while reducing treatment-related complications, reflecting an evolving trend toward individualized patient-centered care.