《2025版美国甲状腺学会成人分化型甲状腺癌管理指南》解读：分化型甲状腺癌的核医学诊治进展

doi:10.19401/j.cnki.1007-3639.2025.09.001

摘要/Abstract

摘要：

2025年美国甲状腺学会（American Thyroid Association，ATA）发布的《2025版美国甲状腺学会成人分化型甲状腺癌管理指南》在分化型甲状腺癌（differentiated thyroid cancer，DTC）术后核医学诊疗方面进行了多项重要更新。本文以2025版ATA指南提出的DATA临床管理框架[DATA即诊断（Diagnosis）、风险-获益评估（risk/benefit Assessment）、治疗决策（Treatment decisions）及治疗反应评估（response Assessment）]为主线，系统梳理DTC术后评估、放射性碘治疗（radioactive iodine therapy，RAIT）决策、治疗反应动态评估及随访策略等方面的核医学研究进展。基于2015版ATA指南及近期研究证据，2025版ATA指南强调术后疗效评估（包括血清学和影像学评估）对实时修正风险分层的关键意义，并将复发风险由原有的低、中、高危三类细化为低、中-低、中-高和高危四类，以更精准地预测结构性复发风险；在RAIT策略方面，明确低危患者不再常规推荐清甲治疗，以减少不必要的辐射暴露，并指出重组人促甲状腺激素（recombinant human thyroid stimulating hormone，rhTSH）在低、中危患者RAIT前准备中的优先地位。本指南针对诊断性放射性碘全身显像（diagnostic whole body scan，DxWBS）、¹⁸F-FDG正电子发射计算机体层成像（positron emission tomography and computed tomography，PET/CT）等核医学分子影像学方法在临床实践中的适用场景予以进一步明确；同时，围绕RAIT后的随访策略、重复RAIT的适应证以及放射性碘难治性DTC（radioactive iodine-refractory DTC，RAIR-DTC）的判定标准与管理原则，本文提炼了2025版ATA指南中相关更新要点。

关键词: 分化型甲状腺癌, DATA（诊断、风险-获益评估、治疗决策及治疗反应评估）, 核医学诊疗, 指南解读, 放射性碘难治性

Abstract:

The “2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer” released by the American Thyroid Association (ATA) in 2025 include several important updates regarding nuclear medicine diagnosis and treatment for post-operative differentiated thyroid cancer (DTC). This article systematically reviewed advances in the nuclear medicine aspects of post-operative DTC assessment, decision-making for radioactive iodine therapy (RAIT), dynamic response evaluation, and follow-up strategies, guided by the 2025 ATA guidelines’ DATA clinical management framework—Diagnosis, risk/benefit Assessment, Treatment decisions, and response Assessment. Building on the 2015 ATA guidelines and recent research evidence, the 2025 ATA guidelines emphasize the critical importance of post-operative response assessment (including serological and imaging evaluations) for the real-time refinement of risk stratification. It further subcategorizes recurrence risk from the original three categories (low, intermediate, high) to four categories (low, low-intermediate, intermediate-high and high) to more accurately predict the risk of structural recurrence. Regarding RAIT strategy, the 2025 ATA guidelines clearly state that remnant ablation is no longer routinely recommended for low-risk patients to avoid unnecessary radiation exposure, and highlight the preferred use of recombinant human thyroid stimulating hormone (rhTSH) for RAIT preparation in low- and intermediate-risk patients. The 2025 ATA guidelines further clarify the appropriate clinical application scenarios for nuclear medicine molecular imaging methods such as diagnostic whole-body scan (DxWBS) and ¹⁸F-FDG positron emission tomography and computed tomography (PET/CT). At the same time, concerning post-RAIT follow-up strategies, indications for repeated RAIT, as well as the diagnostic criteria and management principles for radioactive iodine-refractory DTC (RAIR-DTC), this article highlighted the key updated points in the 2025 ATA guideline.

Key words: Differentiated thyroid cancer, DATA (Diagnosis, risk/benefit Assessment, Treatment decisions, and response Assessment), Nuclear medicine diagnosis and treatment, Guideline interpretation, Radioactive-iodine refractory

中图分类号:

R736.1

赵翊含, 林岩松. 《2025版美国甲状腺学会成人分化型甲状腺癌管理指南》解读：分化型甲状腺癌的核医学诊治进展[J]. 中国癌症杂志, 2025, 35(9): 815-825.

ZHAO Yihan, LIN Yansong. Interpretation of the 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer: progress in nuclear medicine diagnosis and treatment of differentiated thyroid cancer[J]. China Oncology, 2025, 35(9): 815-825.

图/表 4

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Risk category	Typical RAIT recommendation	Recommended ¹³¹I activity level	Goals of therapy
Low	No	1.10-1.85 GBq (30-50 mCi)	None or remnant ablation
Intermediate-low and intermediate-high	Consider	1.10-3.70 GBq (30-100 mCi)	Remnant ablation +/- adjuvant therapy
High	Yes	3.70-5.55 GBq (100-150 mCi)	Remnant ablation and adjuvant therapy
Distant metastases	Yes	3.70-7.40 GBq (100-200 mCi) or consider dosimetry	Treatment of known disease, remnant ablation