Improved adequacy of levothyroxine treatment in low-risk differentiated thyroid cancer using the 2025 American Thyroid Association (ATA) criteria: a multicenter real-world analysis of 1,016 patients
Authors' conclusion
Applying the ATA-2025 criteria increases the proportion of patients classified as having adequate TSH control and decreases the proportion labeled as over- or undertreated under the 2015 framework, reflecting the broader, risk-adapted TSH targets introduced in 2025.
Study context
- Population
- Adults with low-risk differentiated thyroid cancer (DTC) on LT4; median follow-up 79 months
- Participants
- 1,016 adults
- Exposure
- ATA-2025 vs ATA-2015 criteria for LT4 treatment adequacy
- Outcome
- LT4 treatment adequacy (framework-specific TSH targets) and dynamic risk stratification
- Follow-up
- 12 months and last visit
Methodological detailsmulticenter, real-world
- Multicenter
- Real-world
Main finding
As reported in the abstract
Adequacy at 12 months: ATA-2015 vs ATA-2025
26.0% vs 40.7
Adequacy at last visit: ATA-2015 vs ATA-2025
39.6% vs 67.4%
Observational data: associations, not effects.
Secondary outcomes
Excellent response · 12 months and last visit
- Excellent response at 12 months: ATA-2025 vs ATA-2015
- 72.0% vs 62.3
- Excellent response at last visit: ATA-2025 vs ATA-2015
- 86.9% vs 77.8%
Overtreatment among excellent responders · 12 months and final evaluation
- ATA-2015, 12 months; final evaluation
- 61.8%; 30.5%
- ATA-2025, 12 months; last visit
- 51.9 and 25.5%
Undertreatment among indeterminate responders · 12 months and final evaluation
- ATA-2015, 12 months; final evaluation
- 48.4%; 62.2%
- ATA-2025, 12 months; last visit
- 6.6 and 8.8%
Factors associated with adequacy (multivariable, last visit)
- Older age (OR per year, 1.00-1.03)
- 1.02
- LT4 dose instability (OR for adequacy, 0.08-0.16)
- 0.12
- Among excellent or indeterminate responders
Original publication
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