Thyroid malignancy
The main thyroid cancer types and how they behave, de-escalated treatment of differentiated thyroid cancer under the 2025 ATA guideline (lobectomy up to 2 to 4 cm, active surveillance of microcarcinoma, no routine RAI for low risk, TSH by response), thyroglobulin follow-up, and when to think anaplastic, medullary or lymphoma.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Almost all thyroid cancer is differentiated (papillary or follicular) and has an excellent prognosis: over 95% 10-year survival for low-risk disease.
- Australian incidence more than doubled over three decades with little change in mortality, mostly from small papillary cancers found on imaging. Nodule work-up (TSH, ultrasound, FNA, Bethesda) is in Thyroid nodules.
- The 2025 ATA guideline replaced the 2015 cancer sections and de-escalates treatment: lobectomy for most tumours up to 2 cm (and many to 4 cm), active surveillance for selected microcarcinomas, no routine radioiodine for low-risk disease, normal-range TSH after an excellent response.
Loading the rest of the note…
Finished reading?
Sources
- 2025 American Thyroid Association management guidelines for adult patients with differentiated thyroid cancerAmerican Thyroid Association (Ringel, Sosa et al., Thyroid 2025;35(8):841-985), 2025 (erratum November 2025; checked November 2026 as current)
- Revised American Thyroid Association guidelines for the management of medullary thyroid carcinomaAmerican Thyroid Association (Wells et al., Thyroid 2015;25:567-610), 2015
- Mallick U, Harmer C, Yap B et al. Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer (HiLo). N Engl J Med 2012;366:1674-85New England Journal of Medicine, 2012
- Schlumberger M, Tahara M, Wirth LJ et al. Lenvatinib versus placebo in radioiodine-refractory thyroid cancer (SELECT). N Engl J Med 2015;372:621-30New England Journal of Medicine, 2015
- Lenvatinib (PBS Schedule item, differentiated thyroid cancer, Authority Required (Streamlined))AU/NZPharmaceutical Benefits Scheme, Checked November 2026
- Selpercatinib 40 mg (PBS Schedule item 15447B, advanced or metastatic medullary thyroid cancer, Authority Required (Streamlined))AU/NZPharmaceutical Benefits Scheme, Checked November 2026
- Cabozantinib 60 mg (PBS Schedule item 14224P, RAI-refractory differentiated thyroid cancer after a VEGF-targeted TKI, Authority Required (Streamlined))AU/NZPharmaceutical Benefits Scheme, Checked November 2026
- Endocrinology (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Deploy to Cloudflare on push to main