A 62-year-old man with newly diagnosed papillary thyroid carcinoma (1.8 cm, pT1bN0M0, no BRAF mutation on molecular testing) undergoes total thyroidectomy. According to the 2015 ATA risk stratification, this patient is classified as:

• A Very low risk; active surveillance without radioiodine is appropriate
• B Low risk; radioiodine is generally not recommended ✓
• C Intermediate risk; routine adjuvant radioiodine is indicated
• D High risk; external beam radiation plus radioiodine required

Explanation

Per 2015 ATA guidelines, pT1b (1-2 cm) N0M0 papillary thyroid carcinoma without high-risk features (vascular invasion, tall-cell variant, BRAF mutation, etc.) falls into the low-risk category. Radioiodine ablation is generally not recommended for low-risk disease (distant metastasis-free survival is excellent with surgery alone). Intermediate-risk applies to microscopic extrathyroidal extension, lymphovascular invasion, or certain histological subtypes. High-risk requires gross extrathyroidal extension or distant metastases.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.