The ATA (American Thyroid Association) 2015 guidelines classify differentiated thyroid cancer into risk categories for recurrence. Which feature places a patient in the HIGH risk category for recurrence?

• A Multifocal papillary thyroid microcarcinoma with BRAF mutation
• B T3a papillary thyroid carcinoma (>4 cm) with no extrathyroidal extension
• C Macroscopic extrathyroidal extension (T4) ✓
• D N1a (central compartment) nodal metastasis with <5 nodes

Explanation

The ATA 2015 guidelines classify macroscopic extrathyroidal extension (gross ETE, T4 disease) as a high-risk feature for structural disease recurrence, associated with markedly increased locoregional recurrence rates. T3a disease (>4 cm) without ETE falls in the intermediate risk category. N1a with fewer than 5 involved nodes is intermediate risk. Multifocal microcarcinoma with BRAF is also intermediate risk.

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.