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