From static stratification to dynamic risk: how to interpret today the concept of risk of recurrence in the ata guidelines for differentiated thyroid carcinoma
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Abstract
Differentiated thyroid carcinoma (DTC) carries a favorable prognosis in most patients; however, its clinical and biological heterogeneity requires stratification systems that allow individualized therapeutic management and follow-up. Objective: to critically analyze the concept of risk of recurrence in DTC in light of the 2025 ATA guidelines, with emphasis on its practical application in the Argentine clinical setting. Development: this review examines changes in histological classification, the complementary role of the AJCC/TNM staging system, and the ATA risk of recurrence stratification system, with particular attention to the most relevant clinicopathological variables and the emerging role of molecular profiling. We also analyze the concept of dynamic risk and the modifications introduced by the 2025 ATA guidelines, including early postoperative assessment, new thyroglobulin cutoff values, changes in response categories for lobectomy patients, and updated TSH suppression recommendations. Conclusion: dynamic risk assessment has become the central paradigm of contemporary DTC management, offering greater individual predictive capacity than static classification systems alone. The correct interpretation and integration of these tools, adapted to the local clinical context, is essential for informed decision-making in daily practice.
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