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WorksheetsThyroid ATA 2025
Total questions: 20
Worksheet time: 10mins
A 45-year-old woman presents with a 1.8 cm thyroid nodule. Ultrasound shows spongiform appearance with smooth margins and no suspicious features. Per 2025 ATA nodule guidelines, what is the next step?
Fine-needle aspiration (FNA) biopsy
Repeat ultrasound in 12-24 months
Molecular testing
Diagnostic lobectomy
In a 55-year-old man with a 2.5 cm nodule showing irregular margins and punctate echogenic foci (high-suspicion pattern), what is the FNA size threshold per 2025 ATA guidelines?
≥1.0 cm
≥1.5 cm
≥2.0 cm
≥3.0 cm
A 38-year-old with a family history of non-medullary thyroid cancer asks about screening. According to 2025 ATA guidelines, what is recommended?
Annual thyroid ultrasound starting at age 18
Routine screening not recommended unless specific mutations
TSH and ultrasound every 2 years
CT neck at baseline
A 60-year-old diabetic patient plans GLP-1 RA therapy for weight loss. 2025 ATA guidelines advise on thyroid screening:
Mandatory ultrasound before starting therapy
Ultrasound not recommended prior to GLP-1 RA
FNA of any nodule >1 cm
Annual screening for 5 years
Post-FNA Bethesda III nodule in a 42-year-old woman. 2025 ATA emphasizes molecular diagnostics for indeterminate cytology. Which is expanded in role?
Only BRAF testing
Comprehensive molecular panels
Routine ThyroSeq alone
No molecular testing recommended
A 50-year-old with a 3.5 cm low-risk papillary thyroid microcarcinoma (PTMC) confined to one lobe, no ETE. 2025 ATA surgical recommendation?
Total thyroidectomy mandatory
Lobectomy sufficient
Active surveillance preferred
Thermal ablation first-line
In cN0 low-risk DTC ≤4 cm, 2025 ATA on prophylactic central neck dissection (CND):
Routine for all PTC
Not recommended routinely
Only if tumor >2 cm
Combined with lateral dissection
A high-volume surgeon operates on a 4.5 cm PTC with ETE. 2025 ATA stresses:
All cases by general surgeons
Referral to high-volume endocrine surgeons for complex cases
No surgeon volume impact
Resident-led for training
Post-lobectomy for low-risk DTC, pathology shows NIFTP(Noninvasive Follicular Thyroid Neoplasm). 2025 ATA management:
Completion thyroidectomy and RAI
No further surgery or RAI
TSH suppression lifelong
Routine neck ultrasound every 6 months
A 52-year-old woman post-total thyroidectomy for intermediate-risk DTC has undetectable Tg, negative imaging at 6-12 months. 2025 ATA defines this as:
Biochemical incomplete response
Excellent response (complete remission)
Structural incomplete
Indeterminate response
For low-risk DTC with excellent response, 2025 ATA follow-up de-escalation includes:
Annual stimulated Tg and WBS
Less frequent unstimulated Tg/ultrasound
Routine CT/MRI every 2 years
FDG-PET annually
Preoperative imaging for suspected DTC with retrosternal extension. 2025 ATA recommends:
Routine FDG-PET for all
CT/MRI for distant metastasis evaluation
No preoperative CT
Ultrasound only
A benign nodule >2 cm causing compressive symptoms. 2025 ATA indications for thermal ablation include:
All benign nodules
Symptomatic benign nodules
Only malignant
Routine post-FNA
2025 ATA introduces DATA framework for DTC: Diagnosis, risk/benefit Assessment, Treatment, and:
Thyroglobulin monitoring
Response Assessment
Active surveillance
Ablation therapy
High-intermediate risk DTC category added in 2025 ATA includes features like:
Only age >55
Minor ETE, vascular invasion
Distant mets only
NIFTP
Post-op low-risk DTC patient with stable TgAb elevation but no structural disease. 2025 ATA dynamic risk stratification:
Escalate to RAI
Adjust follow-up based on response
Ignore TgAb
Routine biopsy
Surgeon refers recurrent nodal disease for ablation. 2025 ATA supports minimally invasive options like:
Only surgery
RFA, ethanol, laser for select recurrences
RAI first
EBRT routine
Preoperative labs for DTC workup per 2025 ATA:
TSH only
Tg + anti-TgAb baseline
Calcitonin routine
Free T4 only
Very low-suspicion nodule (5% malignancy risk) with no FNA criteria. 2025 ATA:
FNA mandatory
No FNA or follow-up
Biopsy anyway
Lobectomy
Patient-reported outcomes emphasized in 2025 ATA for survivorship focus on:
Only survival rates
Quality of life, side effects
Cost only
Imaging frequency
