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Originally published August 27, 2026
Last updated August 27, 2026
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Thyroid cancer is usually a highly treatable malignancy with overall five-year survival rates over 98%. Many patients with thyroid cancer go on to live for several decades after their disease is cured.
That’s a primary reason why thyroid cancer specialists like Daniel Kwon, MD, a head and neck cancer surgeon with the USC Head and Neck Center, which includes experts from the USC Caruso Department of Otolaryngology – Head and Neck Surgery and the USC Norris Comprehensive Cancer Center of Keck Medicine of USC, treat the disease with an emphasis on reducing potential long-term side effects from treatment that can impact quality of life.
“Historically in this field, we probably overtreated patients who perhaps didn’t need as aggressive of treatment,” Kwon says. He explains that over the years, recent studies have allowed for “more personalized treatment recommendations for different patients instead of just, ‘You have thyroid cancer, so your entire thyroid is coming out.’”
A major advancement is the growing use of molecular testing in thyroid cancer care. “It’s virtually standard of care, with most insurance providers covering it,” Kwon says.
Many patients avoid unnecessary surgeries with molecular testing. On average, 20%-30% of fine-needle aspiration biopsies yield indeterminate results. Molecular testing on the biopsy sample can help classify the nodule as high or low risk for cancer when cytopathology is unable to make a clear diagnosis.
Molecular testing can also help guide therapy decisions. High-risk mutational patterns can point to more aggressive, fast-growing disease and elevated recurrence risk.
Surgeons use the results to help determine whether a patient will benefit more from a total thyroidectomy or a lobectomy. It can also help guide additional testing, imaging or adjuvant treatment. In advanced cases, specialists can also offer targeted therapies such as RET inhibitors, BRAF/MEK inhibitors and TRK inhibitors designed specifically for the patient’s unique gene alteration.
Another change in thyroid cancer treatment has to do with how the disease is classified.
Papillary and follicular thyroid cancer are the most common forms of the disease, accounting for more than 90% of cases. Updated guidelines from the American Thyroid Association recategorized oncocytic thyroid cancer as a separate subtype, rather than as a subset of follicular thyroid cancer.
In addition, when determining risk recurrence, ATA guidelines now include four categories rather than three: low, low-intermediate, intermediate-high, and high.
Kwon says these changes help support individualized care rather than one-size-fits-all. “It helps us give even more detailed treatment recommendations and surveillance approaches.”
The 2025 ATA guidelines include an emphasis on treatment de-escalation for lower-risk cases. For many surgical patients, this means a lobectomy instead of a total thyroidectomy.
A lobectomy, or partial removal of the thyroid gland, can be recommended for patients with tumors smaller than four centimeters. The cancer is usually restricted to one lobe and hasn’t spread to other areas.
“A lobectomy for a low-risk tumor is preferable for most young, otherwise healthy patients, in my opinion,” Kwon says. “The oncologic outcomes are the same as a full removal. And the majority of patients don’t need to take medications afterward, whereas if you remove the entire thyroid, they’re dependent on thyroid hormone-replacement for the rest of their life.”
He adds that a lobectomy reduces overall surgical risk such as infections, bleeding, nerve injuries and air leaks. “At a high-volume thyroid cancer treatment center like at Keck Medicine, where we do hundreds of thyroid surgeries each year, our complication rates are very low. But it’s not zero.”
“Surgery is the cornerstone of treatment for thyroid cancer, and most people don’t need more treatment after that,” Kwon continues. “But if they do, then radioactive iodine is the main tool we use.”
Radioactive iodine (RAI) is generally used to treat high-risk patients with invasive or metastatic disease. Long-term complications from this therapy are rare but can include chronic dry mouth, dry eyes, salivary gland damage and an increased risk of other cancers.
Kwon says the updated risk recurrence categories from the ATA offers physicians guidance on the appropriate RAI plan for each patient.
For some patients with very small thyroid tumors and slow-growing disease, active surveillance can be an appropriate course of action. Kwon says this is especially true for patients who either don’t want surgery or are considered high-risk for surgery.
“A good example would be someone who previously had an injury to their voice box or had a stroke and has poor laryngeal function, and doing a thyroid surgery would introduce additional risk,” Kwon says.
Ultimately, to help patients determine the right treatment for them, Kwon advises seeking specialized thyroid care.
“De-escalation in thyroid cancer care isn’t about doing less. It’s about identifying which patients actually need surgery, radioactive iodine or targeted therapies,” Kwon says. “At Keck Medicine, we have the expertise to interpret the data and make a more personalized recommendation for each patient.”
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