Endo in a Bite

In this episode, we review recommendations 73 to 84 from the 2025 American Thyroid Association guidelines on managing radioiodine refractory differentiated thyroid cancer and survivorship care.
Key topics include:

• Use of immunotherapy, redifferentiation therapy, and local or systemic treatments for advanced disease.

• Pregnancy management, including timing of surgery, imaging considerations, and TSH goals.

• Long term follow up focusing on side effect monitoring, financial counseling, and psychosocial support.

In this episode, we review recommendations 57 to 72 from the 2025 American Thyroid Association guidelines on the management of radioiodine avid and radioiodine refractory differentiated thyroid cancer.
Key topics include:

• The role of RAI therapy for iodine avid bone metastases and rising thyroglobulin levels

• Criteria and management strategies for RAIR disease

• Monitoring and follow up of stable or progressive RAIR metastatic DTC

• Indications for molecular testing and tissue based biomarker assessment

• Recommended systemic therapies including multikinase inhibitors (lenvatinib, sorafenib, cabozantinib)

• Targeted therapies for NTRK, RET, ALK, and BRAFV600E mutations

• Dose management, adverse event monitoring, and strategies for treatment sequencing

• The importance of tumor biopsy and next-generation sequencing to guide therapy for resistant disease

In this episode, we review recommendations 51 to 56 from the 2025 American Thyroid Association guidelines on long term management of differentiated thyroid cancer. Key topics include:

• The role of ongoing (dynamic) risk stratification in individualized patient management

• Decision making for reoperative neck surgery and alternative local therapies such as ethanol and RFA

• Indications for additional RAI therapy for cervical lymph node metastases

• The role of EBRT in unresectable locoregional recurrences

• Radioactive iodine dosing strategies and preparation methods, including dosimetry and TSH stimulation

• Management of metastatic disease with RAI, including treatment of pulmonary micrometastases and macronodular metastases

In this episode, we review recommendations 45 to 50 from the 2025 American Thyroid Association guidelines on long term management of differentiated thyroid cancer. Key topics include:

• Individualization of TSH suppression strategy

• Long term considerations for TSH suppression in low and intermediate risk patients

• Monitoring serum thyroglobulin and Tg antibodies as markers of disease status

• Follow up protocols for low risk differentiated thyroid cancer, including when to discontinue ultrasound and biochemical monitoring

• The role of radioiodine whole body scintigraphy in follow up care

•Indications for advanced imaging with fluorodeoxyglucose PET/CT in high risk patients

In this episode, we break down recommendations 41 to 44 from the 2025 American Thyroid Association guidelines on differentiated thyroid cancer management. Key topics include:

• Patient counseling on the small risk of second primary malignancy after RAI

• Baseline labs: complete blood count and kidney function before RAI therapy

• Reproductive considerations: pregnancy precautions, nursing patient guidance, and fertility counseling

• Adjuvant external beam radiotherapy (EBRT) for high risk cases, balancing locoregional control with potential toxicity

In this episode, we review key updates from the 2025 American Thyroid Association guidelines on surveillance and radioactive iodine management for adult patients with differentiated thyroid cancer.

• Surveillance: Ultrasound as first line follow up; 6 to12 month intervals; FNA for nodes ≥10 mm; CT or PET for rising thyroglobulin without visible disease

• Radioactive Iodine: Not routine in low risk; recommended for high risk and metastatic cases; role in oncocytic thyroid carcinoma still uncertain

• Preparation for RAI Therapy: Recombinant TSH preferred; TSH goal greater than 30 mIU/L; low iodine diet before treatment

• Imaging: Pre and post therapy scans are essential

• Safety: Oral and written radiation precautions for patients and families

• Adverse Effects: Salivary gland dysfunction, xerostomia, and lacrimal duct problems, with hydration and preventive dental care recommended

• Takeaway: Ultrasound and thyroglobulin trends guide surveillance, RAI therapy should be tailored to patient risk, and careful preparation along with safety measures are critical for long term management

In this episode, we break down recommendations 21 to 30 from the 2025 American Thyroid Association guidelines on differentiated thyroid cancer management. Key topics include:

• Preoperative discussion of surgical risks, including nerve and parathyroid injury

• Preoperative and postoperative voice assessment and laryngeal examination

• Intraoperative nerve identification and monitoring strategies

• Parathyroid preservation and autotransplantation, with calcium and vitamin D supplementation

• Avoidance of routine thyroidectomy drains

• Pathology reporting beyond AJCC staging, including vascular invasion, nodal status, and histologic subtypes

• Updated 2025 risk stratification and ATA response criteria

• Postoperative thyroglobulin measurement for guiding further management

In this episode, we review key updates from the 2025 American Thyroid Association guidelines on surgical management for adult patients with differentiated thyroid cancer.

• Surgery by tumor size: lobectomy for small, low risk tumors; total thyroidectomy for larger or advanced tumors

• Thyroglossal duct carcinoma: Sistrunk procedure and thyroidectomy for higher risk cases

• Central and lateral neck lymph node surgery: therapeutic vs. prophylactic approaches

• General surgical principles: avoid overtreatment, preserve thyroid function, and maximize oncologic control

• Numbers to remember: tumor sizes, surgical approaches, and key risk based strategies

This bonus summary episode distills the Endocrine Society’s 2025 guideline updates on primary aldosteronism into high yield pearls for clinical practice and board preparation. Key topics include:

• Broad screening for hypertensive patients regardless of potassium status

• Diagnostic evaluation with the aldosterone to renin ratio

• Selective use of suppression testing and updated terminology

• Adrenal vein sampling (AVS) as the gold standard for lateralization

• Surgical vs. medical management based on disease laterality

• Mineralocorticoid receptor antagonist therapy, titration, and renin response

• Cortisol cosecretion testing and its role in surgical planning

• Individualized treatment strategies to improve cardiovascular and metabolic outcomes

In this episode, we review key updates from the 2025 ATA guidelines on surgical referral, imaging, and risk based management for adult patients with differentiated thyroid cancer.

• Referral to high volume thyroid surgeons (≥25 to 50/year) for better outcomes

• Comprehensive neck ultrasound; FNA for suspicious nodes ≥8 to 10 mm

• Use CT or MRI if ultrasound is insufficient for invasive or bulky disease

• Avoid routine preoperative thyroglobulin, antibody testing, and genomic profiling unless it informs surgical planning

• Active surveillance for very low risk papillary thyroid cancers (≤1 cm, intrathyroidal)

• Percutaneous ablation as an alternative for select low risk patients

• Indications for surgery: tumor growth ≥3 mm, nodal metastases, extrathyroidal extension, or patient preference