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

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