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Purpuse <p>To compare dynamic risk stratification (DRS) according to the 2015 American Thyroid Association-Momesso et al. 2016 extension (ATA2015-M) and the 2025 ATA update in low-risk differentiated thyroid cancer (DTC) managed without radioactive iodine (I-131), and to explore the role of an intermediate thyroglobulin (Tg) cutoff of 1 ng/mL.</p> Methods <p>We conducted a retrospective analysis of a prospectively collected cohort of 74 low-risk DTC patients treated with total thyroidectomy (n = 55) or hemithyroidectomy (n = 19) between 2020 and 2024. Clinical, histopathological, and biochemical data were collected. DRS was assessed at the first follow-up visit (6 months after surgery) and at the last visit (median follow-up 27 months [IQR 16–41]) using ATA2015-M and ATA2025 criteria. An exploratory analysis applying a Tg cutoff of 1 ng/mL was performed.</p> Results <p>According to ATA2015-M, excellent response (ER) rates in total thyroidectomy patients increased from 49.2% at baseline to 52.8% at final follow-up. In contrast, ATA2025 classified 89.1% as ER at baseline and 98.2% at final follow-up (p &lt; 0.001). Using the intermediate cutoff of 1 ng/mL, ER rates were 80.0% and 89.1%, respectively. Reclassification to ER under ATA2025 was primarily driven by anti-thyroglobulin antibody (TgAb) negativization, as Tg values remained stable and below the new 2.5 ng/mL threshold. No structural incomplete responses were observed.</p> Conclusion <p>ATA2025 criteria substantially increase ER classification in low-risk DTC patients managed without I-131 compared with ATA2015-M. A 1 ng/mL Tg cutoff may provide a more realistic representation of clinical practice. The dynamic trend of TgAb, rather than their presence alone, is a key determinant for reclassification during follow-up.</p>

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Comparative evaluation of dynamic risk stratification according to ATA 2015 and ATA 2025 in low-risk differentiated thyroid cancer without radioiodine ablation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月16日

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  • Pablo Fernández Velasco,
  • Paula Peciña Melgosa,
  • Beatriz Torres Torres,
  • Luis Miguel Torres Morientes,
  • Ana Fernández Rodríguez,
  • Marta Alonso Mesonero,
  • Marta de Uribe Viloria,
  • María Álvarez Quiñones,
  • Jaime Santos Pérez,
  • Daniel de Luis Román,
  • Gonzalo Diaz-Soto

摘要

Purpuse

To compare dynamic risk stratification (DRS) according to the 2015 American Thyroid Association-Momesso et al. 2016 extension (ATA2015-M) and the 2025 ATA update in low-risk differentiated thyroid cancer (DTC) managed without radioactive iodine (I-131), and to explore the role of an intermediate thyroglobulin (Tg) cutoff of 1 ng/mL.

Methods

We conducted a retrospective analysis of a prospectively collected cohort of 74 low-risk DTC patients treated with total thyroidectomy (n = 55) or hemithyroidectomy (n = 19) between 2020 and 2024. Clinical, histopathological, and biochemical data were collected. DRS was assessed at the first follow-up visit (6 months after surgery) and at the last visit (median follow-up 27 months [IQR 16–41]) using ATA2015-M and ATA2025 criteria. An exploratory analysis applying a Tg cutoff of 1 ng/mL was performed.

Results

According to ATA2015-M, excellent response (ER) rates in total thyroidectomy patients increased from 49.2% at baseline to 52.8% at final follow-up. In contrast, ATA2025 classified 89.1% as ER at baseline and 98.2% at final follow-up (p < 0.001). Using the intermediate cutoff of 1 ng/mL, ER rates were 80.0% and 89.1%, respectively. Reclassification to ER under ATA2025 was primarily driven by anti-thyroglobulin antibody (TgAb) negativization, as Tg values remained stable and below the new 2.5 ng/mL threshold. No structural incomplete responses were observed.

Conclusion

ATA2025 criteria substantially increase ER classification in low-risk DTC patients managed without I-131 compared with ATA2015-M. A 1 ng/mL Tg cutoff may provide a more realistic representation of clinical practice. The dynamic trend of TgAb, rather than their presence alone, is a key determinant for reclassification during follow-up.