A 30-year-old woman undergoes hemithyroidectomy for a 2.8 cm follicular thyroid carcinoma with minimal capsular invasion and no vascular invasion. Postoperative staging: T2N0M0 well-differentiated follicular carcinoma. According to current ATA (American Thyroid Association) 2015 guidelines, she is classified as:

• A High risk — requires completion thyroidectomy and radioiodine ablation
• B Low risk — hemithyroidectomy alone is sufficient; completion thyroidectomy not routinely required ✓
• C Intermediate risk — requires completion thyroidectomy but RAI optional
• D Low risk — requires thyroid hormone suppression therapy but no further surgery

Explanation

ATA 2015 guidelines introduced a major change: for low-risk differentiated thyroid cancer (T1-T2, unifocal, no extrathyroidal extension, no vascular invasion, no lymph node or distant metastases), hemithyroidectomy alone is acceptable and completion thyroidectomy is not routinely required. Minimal capsular invasion (without vascular invasion) in follicular carcinoma remains low-risk. This represented a paradigm shift from the previous universal recommendation for total thyroidectomy for all cancers >1 cm.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.