Guideline Video

Guideline Resources

  • Title: Adult Patients with Differentiated Thyroid Cancer
  • Society:  American Thyroid Association (ATA)
  • Publish Date: August 20, 2025
  • Overview
  • Full-text

Video Transcription

Today we’ll be going over The American Thyroid Association’s newest guideline update on Adult Patients with Differentiated Thyroid Cancer (DTC). The objective of this guideline update is to provide clinicians, patients, researchers, and those involved in health policy with rigorous, comprehensive, and contemporary guidelines to assist in the management of adult patients with DTC, emphasizing the patient journey beginning with a thyroid cancer diagnosis. 

In today’s video, we’ll just be going over key takeaways of the 2025 update on the sections genetic and molecular testing, multikinase inhibitors, oncogenic driver alterations, and cytotoxic chemotherapy so to get the full recommendations, make sure to check it out on guidelinescentral.com. 

  • Starting with Genetic and Molecular Testing
    • The new 2025 ATA guideline expanded on previous recommendations for genetic and molecular testing as follows:
      • Germline testing may be offered to certain patients.
      • Patients with Familial Non-Medullary Thyroid Cancer (FNMTC) should have regular neck examinations and may undergo screening ultrasounds (US).
      • Biomarker testing is recommended to identify actionable oncogenic driver alterations in patients with Radioiodine-Refractory Differentiated Thyroid Cancer (RAIR DTC) before starting systemic therapy for progressive disease.
  • On to Multikinase Inhibitors (MKI)
    • The new guidelines strengthened recommendations for the use of MKI therapy for patients with RAIR DTC without an actionable biomarker-linked. Recommended first-line MKI treatments are lenvatinib or sorafenib.
    • Patients with symptomatic RAIR DTC who cannot get local therapy should start lenvatinib or other therapy without delay. 
    • Cabozantinib may be offered as a second-line treatment to patients with RAIR DTC without an actionable oncogenic driver alteration who get worse or cannot tolerate their initial MKI. 
  • Moving on to Oncogenic Driver Alterations
    • Patients with progressive RAIR DTC who have the following actionable oncogenic driver alteration should be given targeted treatment for their specific alteration as a first-line therapy
      • NTRK fusion
      • RET fusion
      • ALK fusion.  
    • Patients with progressive RAIR DTC who have an oncogenic BRAF V600E mutation may consider BRAF V600E directed therapy as a first-line treatment if they are not candidates for lenvatinib.
    • Patients with a BRAF V600E mutation who have gotten worse or did not tolerate one or more MKI should be treated with BRAF-directed therapy.
    • BRAF-directed therapies are not recommended for patients with DTC who have non-V600 BRAF alterations.
    • Enrollment in a clinical trial or first-line lenvatinib is suggested for patients with progressive RAIR DTC who have other potential actionable targets.
  • And last, for the section on Cytotoxic Chemotherapy
    • Cytotoxic chemotherapy agents continue to be offered to patients with RAIR DTC as a treatment of last resort, preferably within a therapeutic clinical trial.

And there you have it. Make sure to check out the full guideline from The American Thyroid Association and other related clinical decision support tools at guidelinecentral.com.

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