Clinical Thyroidology for the Public summarizes selected research studies discussed in the previous month’s issue of Clinical Thyroidology, an official publication of the American Thyroid Association. Editor-in-chief, Alan Farwell, MD, FACE
Volume 19 Issue 3
Available in pdf format for saving and printing and Web page format for viewing online
PDF Format for Saving and Printing
Clinical Thyroidology for the Public Volume 19 Issue 3 (PDF file, 2.37 MB)
TABLE OF CONTENTS – Web Format
HYPOTHYROIDISM
Can levothyroxine be taken with breakfast?
The absorption of levothyroxine is affected by acid levels in the stomach, so patients are advised to take levothyroxine in an empty stomach and wait at least 30-60 minutes before eating breakfast. However, some patients may find this recommendation difficult to follow, leading to missed or decreased effectiveness of levothyroxine and inadequate treatment of hypothyroidism. The researchers of the study aimed to assess if taking a higher dose of levothyroxine with breakfast would still result in stable thyroid function compared to taking a lower dose of levothyroxine before breakfast.
Willems JIA, et al. Fasting vs non‑fasting, dose‑adjusted levothyroxine ingestion in hypothyroidism: a randomized clinical trial. J Clin Endocrinol Metab. Epub 2025 Dec 23; doi: 10.1210/clinem/dgaf686. PMID: 41431302.
THYROID NODULES
Large thyroid nodules: how reassuring is a benign biopsy result?
Thyroid biopsy is the main test to determine whether a nodule is cancer or benign. However, some studies suggest that a thyroid biopsy is less reliable in evaluating large nodules. The goal of this study was to determine the cancer rate of large thyroid nodules and evaluate the diagnostic accuracy of biopsy results of large nodules by comparing the biopsy findings with the final surgical pathology results.
Swaminathan N, et al. Malignancy risk and diagnostic accuracy of fine-needle aspiration in thyroid nodules ≥4 cm: a retrospective analysis of incidental cancer. Am Surg. Epub 2025 Dec 9; doi: 10.1177/00031348251407348. PMID: 41363024.
THYROID SURGERY
Reaching a high-volume thyroid surgeon depends on more than where you live
High-volume thyroid surgeons are those that perform >25-100+ operations annually and have better outcomes, lower complication rates and shorter hospital stays as compared to low-volume surgeons. However, many thyroid surgeries in the US are performed by surgeons who do very few of these procedures each year. This study aimed to better understand how factors such as where a patient lives, their insurance, and other personal factors influence access to more experienced surgical care.
Jensen CB, et al. Factors associated with receiving thyroid cancer care from high-volume surgeons. J Am Coll Surg. Epub 2025 Dec 8.
THYROID CANCER
2025 ATA Differentiated Thyroid Cancer Guidelines: Completion Thyroidectomy
A significant change in the 2025 thyroid cancer guidelines is an increase in the recommendation of lobectomy. Prior guidelines indicate that completion thyroidectomy is considered in up to 20% of patients with a lobectomy and cancer >2 and ≤4 cm. This paper summarizes the changes in recommendations for completion thyroidectomy in the 2025 ATA differentiated thyroid cancer guidelines.
Ringel MD et al. 2025 American Thyroid Association management guidelines for adult patients with differentiated thyroid cancer. Thyroid 2025;35(8):841-985.
THYROID CANCER
2025 ATA Differentiated Thyroid Cancer Guidelines: TSH suppression
In the 2015 thyroid cancer guidelines, assigning risk of thyroid cancer recurrence (risk stratification) based on the assessment after the initial surgery drove initial TSH suppressive therapy decisions, as very specific TSH targets were recommended. However, treatment changes the risk of recurrence, with an excellent response to therapy having a different prognosis even in a patient with a high-risk cancer. In the 2025 guidelines, a focus on reevaluating risk stratification allows for initial treatment response to play a role in the selection of TSH suppression therapy.
Ringel MD et al. 2025 American Thyroid Association management guidelines for adult patients with differentiated thyroid cancer. Thyroid 2025;35(8):841-985.
THYROID CANCER
2025 ATA Differentiated Thyroid Cancer Guidelines: Systemic Therapy
While the majority of patients with thyroid cancer do very well with an excellent prognosis, 5 to 15% of patients have more advanced cancer which can develop resistance to radioactive iodine therapy, which is linked to markedly worse clinical outcomes. Systemic therapy (ie chemotherapy) is reserved for patients with progressive, symptomatic cancer that fails to respond to radioactive iodine therapy and cannot be surgically removed. The 2025 ATA thyroid cancer guidelines provide the first comprehensive framework directly linking molecular gene mutations in the cancer to available options for treatment.
Ringel MD et al. 2025 American Thyroid Association management guidelines for adult patients with differentiated thyroid cancer. Thyroid 2025;35(8):841-985.
AMERICAN THYROID ASSOCIATION® , ATA® , THYROID® , CLINICAL THYROIDOLOGY® , and the distinctive circular logo are registered in the U.S. Patent and Trademark Office as trademarks of the American Thyroid Association® , Inc.