Hwa Young Ahn

In patients with differentiated thyroid cancer, initial recurrence-risk stratification based on clinical, histopathological, and perioperative findings remains central to management during the first 1–2 years after initial treatment. Ongoing risk stratification (ORS) complements this initial assessment by continuously integrating longitudinal clinical data and treatment response, thereby refining long-term prognostic assessment and supporting individualized risk-adapted management. Building on the 2024 Korean Thyroid Association (KTA) guidelines, the 2026 KTA guideline incorporates new evidence from large Korean multicenter cohorts and comprehensive systematic reviews. The updated recommendations reinforce the continued application of ORS and provide more specific guidance on risk-adapted thyroid-stimulating hormone (TSH) targets, surveillance strategies for recurrence detection, and long-term follow-up tailored to individual recurrence risk and treatment response. Consistent with the evolving paradigm toward risk-adapted and individualized management, this revision updates recommendations regarding target serum TSH levels, serum thyroglobulin thresholds for response assessment and long-term surveillance, and follow-up intervals based on both initial-risk category and the ORS response category. These evidence-based recommendations aim to minimize unnecessary treatment and excessive surveillance in the majority of patients who have an excellent prognosis after initial therapy while ensuring individualized long-term management for patients who require closer surveillance or additional therapeutic intervention.

Eun Kyung Lee, Seung Heon Kang, Bon Seok Koo, Mijin Kim, Min Joo Kim, Bo Hyun Kim, Ji Won Kim, Dong Gyu Na, Sohyun Park, Ji-In Bang, Kyorim Back, Youngduk Seo, Young-Ik Son, Young Shin Song, Dong Yeob Shin, Jong-Hyuk Ahn, Hwa Young Ahn, So Won Oh, Ho-Ryun Won, Won Sang Yoo, Min Kyoung Lee, Sang-Woo Lee, Jeongmin Lee, Ji Ye Lee, Dong-Jun Lim, Ki-Wook Chung, Ari Chong, Jin Hyang Jung, Sun Wook Cho, Yoon Young Cho, Chae Moon Hong, Young Joo Park and Korean Thyroid Association Guideline Committee on the Management of Thyroid Nodule and Cancer. Int J Thyroidol 2026;19:1-40. https://doi.org/10.11106/ijt.2026.19.1.1

Kim HR, et al. J Korean Med Sci. 2026 Jun;41(22):e153. https://doi.org/10.3346/jkms.2026.41.e153

Ye An Kim, Hye Sook Min, Hwa Young Ahn, Young A Kim and Young Joo Park. Int J Thyroidol 2025;18:157-70. https://doi.org/10.11106/ijt.2025.18.2.157

Purpose Graves’ orbitopathy (GO) is a common extrathyroidal manifestation of Graves’ disease (GD) and can be triggered by radioactive iodine (RAI) treatment. However, the incidence or factors influencing GO development after RAI remain unclear. We aimed to investigate the incidence, risk factors, and clinical outcomes of GO following RAI treatment in GD patients. Methods A retrospective cohort study using data from Korea’s National Health Information System (2008–2020) included GD patients treated with RAI from 2008–2018, followed until 2020. GO was identified via diagnostic codes, and risk factors were assessed using Cox proportional hazards models. Clinical outcomes were compared between patients with GO who did and did not undergo RAI. Results Among 12,819 GD patients treated with RAI, 453 (3.5%) developed GO, compared to 4007 (0.3%) of 1,529,386 GD patients without RAI. The median time to GO onset post-RAI was 18.7 months. Younger age, shorter time from GD diagnosis to RAI, and smoking were significant risk factors, while post-RAI levothyroxine use reduced risk. Patients with GO after RAI required more intensive treatments, such as intravenous steroids and orbital radiotherapy, compared to those with GO not receiving RAI. Conclusion GO risk after RAI treatment was higher in younger patients, smokers, and those receiving earlier RAI. Levothyroxine treatment appeared protective. These findings emphasize the importance of patient selection, smoking cessation, timely hormone replacement, and close monitoring to mitigate GO risk and improve outcomes.

The increasing detection of papillary thyroid microcarcinoma (PTMC) has raised concerns regarding overtreatment. For low-risk PTMC, either immediate surgery or active surveillance (AS) can be considered. To facilitate the implementation of AS, the Korean Thyroid Association convened a multidisciplinary panel and developed the first Korean guideline. AS is recommended for adults with pathologically confirmed Bethesda V–VI PTMC who have no clinical evidence of lymph node or distant metastasis, gross extrathyroidal extension, invasion of the trachea or recurrent laryngeal nerve, or aggressive histology. A baseline assessment requires high-resolution neck ultrasound performed by experienced operators to exclude extrathyroidal extension, tracheal or recurrent laryngeal nerve invasion, and lymph node metastasis; contrast-enhanced neck computed tomography is optional. Patient characteristics, including age, comorbidities, and the capacity for long-term follow-up, should be thoroughly assessed. Shared decision-making should carefully weigh the benefits and risks of surgery versus AS, considering expected oncologic outcomes, potential complications, quality of life, anxiety, medical costs, and patient preference. Follow-up involves neck ultrasound and thyroid function tests every 6 months for 2 years and annually thereafter. Disease progression, defined as significant tumor growth or newly detected nodal or distant metastasis, warrants surgery. Despite remaining uncertainties, this guideline provides a structured framework to ensure oncologic safety and supports patient-centered AS.

Objective: Hypoparathyroidism is an uncommon but significant complication of total thyroidectomy. As the incidence of thyroid cancer increases, the prevalence of hypoparathyroidism also increases. However, its effect on the risk of osteoporotic fractures remains poorly understood. We aimed to evaluate the risk of osteoporotic fractures in patients with postoperative hypoparathyroidism compared with that in a matched control group. Design: This retrospective cohort study included 417 patients with hypoparathyroidism who had undergone total thyroidectomy for thyroid cancer (TC with hypoP) and 2085 matched controls from the Korean National Health Insurance Service-National Sample Cohort. Methods: The osteoporotic fracture rates and associated risk factors were analyzed in comparison after propensity score matching. Results: During a median follow-up period of 5.07 years (interquartile range 2.19-7.38), postoperative hypoparathyroidism was not associated with a significantly greater risk of osteoporotic fractures than that in the control group (hazard ratio [HR] 0.86, 95% confidence interval [CI], 0.59-1.24, P = .406). Age-specific analysis showed a trend toward higher fracture incidence in patients aged <50 years (HR 1.31, 95% CI, 0.53-3.22, P = .558) and a decreasing trend in those aged ≥50 years (HR 0.75, 95% CI, 0.51-1.12, P = .163), although the differences were not statistically significant. No significant differences in fracture risk were observed between the TC with and without hypoP groups across all fracture sites. The frequency of osteoporotic medication use was higher in the TC with hypoP group than in the control group, particularly among women aged <50 years. Conclusions: Hypoparathyroidism after total thyroidectomy does not appear to increase the risk of osteoporotic fractures compared with that in matched controls in clinical practice.

Eun Kyung Lee, Min Joo Kim, Seung Heon Kang, Bon Seok Koo, Kyungsik Kim, Mijin Kim, Bo Hyun Kim, Ji-hoon Kim, Shin Je Moon, Kyorim Back, Young Shin Song, Jong-hyuk Ahn, Hwa Young Ahn, Ho-Ryun Won, Won Sang Yoo, Min Kyoung Lee, Jeongmin Lee, Ji Ye Lee, Kyong Yeun Jung, Chan Kwon Jung, Yoon Young Cho, Dong-Jun Lim, Sun Wook Kim, Young Joo Park, Dong Gyu Na and Jee Soo Kim. Int J Thyroidol 2025;18:30-64. https://doi.org/10.11106/ijt.2025.18.1.30

Hwa Young Ahn. Int J Thyroidol 2025;18:15-8. https://doi.org/10.11106/ijt.2025.18.1.15