Abstract:

In 2025, the American Thyroid Association (ATA) divided the management of thyroid nodules and differentiated thyroid cancer (DTC) into two separate guidelines for the first time. This review highlighted the imaging-related updates and compared them with the 2015 ATA guidelines. The 2025 ATA guidelines introduce the following key updates: ① Clarifying recommendations for screening of familial non-medullary thyroid cancer, and proposing that thyroid ultrasound screening is not recommended before treatment for patients who will receive glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy; ② Refined the sonographic malignancy risk stratification system, enabling classification of all nodule types; ③ Increasing size thresholds for fine-needle aspiration (FNA) and emphasized individualized decisions based on age, comorbidities and other factors; ④ Follow-up intervals for nodules not meeting FNA criteria or with benign cytology have been adjusted, and clear ultrasound surveillance endpoints have been proposed; ⑤ A standardized ultrasound protocol is established for active surveillance of cT1aN0M0 papillary thyroid cancer; ⑥ Additional suspicious features, including abnormal blood flow in cervical lymph nodes, are introduced with quantitative evidence; ⑦ Proposing dynamic risk stratification, adjusting follow-up intervals based on the patient’s risk of residual lesion or disease recurrence and their response to treatment, and adding new endpoints for postoperative follow-up for low-risk DTC patients with sustained excellent response; ⑧ Stressing the preoperative use of computed tomography (CT) or magnetic resonance imaging (MRI) to evaluate distant metastasis, while no longer recommending them as routine imaging tools during follow-up; ⑨ Defining indications for thermal ablation: benign nodules, low-risk microcarcinomas and recurrent or metastatic lesions. Guided by evidence-based medicine, the 2025 ATA guidelines promote the transformation of thyroid ultrasound towards “precision, minimal invasiveness, individualization”, providing a new paradigm for the whole-process clinical management of thyroid diseases.

Key words: Thyroid nodule, Differentiated thyroid cancer, American Thyroid Association guidelines, Ultrasound, Computed tomography, Magnetic resonance imaging, Ablation