ATA 2025 risk of recurrence for differentiated thyroid cancer

Enter postoperative pathology and staging findings. The category updates as you go and lists which features drove it.

Histology

Tumor type

PTC FTC / IEFVPTC Oncocytic (OTC)

Aggressive histology Aggressive PTC subtypes per the WHO 2022 classification (Jung CK et al., Endocrinol Metab 2022;37:703–718). Tall cell requires cells ≥3× as tall as wide in ≥30% of the tumor. Hobnail-like degenerative change in classic PTC does not qualify.

None Tall cell Columnar cell Hobnail

High-grade features (poorly differentiated or differentiated high-grade carcinoma)

Primary tumor

Largest tumor dimension (cm)

Focality

Unifocal Unilateral multifocal Bilateral, all foci ≤1 cm Bilateral, any focus >1 cm

Extrathyroidal extension

None Microscopic only Gross, strap muscles (T3b) Gross, beyond strap muscles (T4)

Vascular invasion

Absent Present

Resection

Margin status

R0, negative R1, anterior R1, posterior R2, gross residual

Lymph nodes

Nodal metastases

None (N0 / Nx) Central (N1a) Lateral or mediastinal (N1b)

Distant disease Distant metastases (M1)

Decision support only. Built from the 2025 ATA guideline (Ringel MD, Sosa JA, et al. Thyroid 2025;35(8):841–985, Fig. 2, Estimated Risk of Structural Recurrence). Aggressive subtypes per the WHO 2022 classification (Jung CK et al., Endocrinol Metab 2022, doi:10.3803/EnM.2022.1553). Use with clinical judgment and tumor board review.

Low risk

Estimated structural recurrence <10%