Generated by All in One SEO Pro v5.0.0.1, this is an llms.txt file, used by LLMs to index the site. # TIRO Thyroid Int'l Recommendations Online ## Sitemaps - [XML Sitemap](https://tiro.expert/sitemap.xml): Contains all public & indexable URLs for this website. ## Posts - [Follicular Thyroid Lesions: What Pathology Reveals with Dr. Baloch](https://tiro.expert/2026/07/follicular-thyroid-lesions-what-pathology-reveals-with-dr-baloch/) - Dr. Dana Hartl welcomes thyroid pathologist Dr. Zubair Baloch for a practical discussion of follicular-patterned thyroid lesions and why they remain challenging to classify. Dr. Baloch explains that “follicular” can describe both a cell of origin and a growth pattern, then walks listeners through the overlap among benign nodules, adenomas and carcinomas. He also clarifies - [Small Thyroid Nodules: When to Watch, Biopsy or Treat with Dr. Alexander](https://tiro.expert/2026/06/small-thyroid-nodules-when-to-watch-biopsy-or-treat-with-dr-alexander/) - In this episode of Voices of Wisdom, Dr. Erik Alexander joins Dr. Dana Hartl for a practical conversation about managing small thyroid nodules in an era of widespread ultrasound use and increasing incidental findings. The discussion centers on how clinicians can weigh nodule size, ultrasound features, cytology, patient age, comorbidities and personal risk tolerance when - [2025 Updated ATA Guidelines with Dr. Sosa: What Has Changed? (Part 2)](https://tiro.expert/2026/05/2025-updated-ata-guidelines-with-dr-sosa-what-has-changed-part-2/) - What happens when the evidence is incomplete, the terminology changes and the old follow-up habits no longer fit? In Part 2 of this thoughtful conversation, Dr. Julie Ann Sosa takes listeners into the gray zones of the 2025 ATA guidelines, from pathology and posterior tumors to surveillance limits and the future of decision support. It - [2025 Updated ATA Guidelines with Dr. Sosa: What Has Changed?](https://tiro.expert/2026/04/2025-updated-ata-guidelines-with-dr-sosa-what-has-changed/) - In Part 1 of their discussion, Dr. Dana Hartl and Dr. Julie Ann Sosa unpack the years-long process behind the update and the biggest shifts already changing how clinicians think about surgery, surveillance and personalized care. It is an inside look at guideline-making that feels as revealing as the recommendations themselves. - [Medullary Thyroid Carcinoma (Part 2): A Surgeon’s Perspective with Dr. Lorenz](https://tiro.expert/2026/03/medullary-thyroid-carcinoma-part-2-a-surgeons-perspective-with-dr-lorenz/) - In part 2, we examine evolving surgical paradigms in medullary thyroid carcinoma, including staged surgery, de-escalation strategies and the use of frozen section findings to guide extent of resection. Dr. Lorenz also discusses follow-up after limited surgery and when neoadjuvant RET inhibitor therapy may make previously unresectable disease operable. - [Beyond Bethesda (Part 2): FNA, Molecular Tests & AI in Pathology with Dr. Baloch](https://tiro.expert/2026/01/beyond-bethesda-part-2-fna-molecular-tests-ai-in-pathology-with-dr-baloch/) - In this second part of their discussion, Dr. Dana Hartl sits down with Dr. Zubair Baloch for a practical conversation on what actually makes thyroid FNA cytology reliable. The episode challenges common assumptions about “adequate” sampling and why that single step quietly shapes every diagnosis that follows. They also tease how molecular testing and AI - [Beyond Bethesda: Cytopathologic Diagnosis of Thyroid Tumors](https://tiro.expert/2025/12/beyond-bethesda-cytopathologic-diagnosis-of-thyroid-tumors/) - Thyroid cytology can be clear at the extremes, but uncertainty dominates the middle ground. In this episode, Dr. Zubair Baloch explores why indeterminate nodules challenge clinicians and how context, judgment, and collaboration shape better decisions. It’s a thoughtful look at what lies beyond Bethesda—and why everything matters. - [Personalizing Thyroid Hormone Therapy in Cancer Care](https://tiro.expert/2025/11/personalizing-thyroid-hormone-therapy-in-cancer-care/) - In this episode, Dr. Dana Hartl speaks with Dr. J.P. Brito from the Mayo Clinic about the art and science of thyroid hormone replacement therapy. Together, they explore balancing TSH suppression, managing persistent symptoms, and understanding when “normal” lab results don’t tell the full story. Tune in for expert insights that challenge assumptions and highlight - [Intraoperative Neuromonitoring: What Clinicians Should Know](https://tiro.expert/2025/10/intraoperative-neuromonitoring-what-clinicians-should-know/) - What if surgeons could see nerve function in real time—and prevent injury before it happens? In this episode, Dr. Catherine Sinclair reveals how intraoperative neuromonitoring is reshaping thyroid surgery worldwide. From technical nuances to global access challenges, listeners gain a rare insider’s look at how innovation is transforming surgical precision. - [Expert Tips & Tricks for Thyroid Cancer Ultrasound](https://tiro.expert/2025/09/expert-tips-tricks-for-thyroid-cancer-ultrasound/) - Dr. Lisa Orloff shares practical, experience-driven tips for optimizing thyroid cancer ultrasound—from honing diagnostic skills and scanning overlooked areas to guiding surgery and follow-up care. Her expert insights help clinicians improve accuracy, integrate ultrasound into patient management, and adopt interactive techniques for better outcomes. - [Understanding Financial Toxicity in Thyroid Cancer](https://tiro.expert/2025/08/understanding-financial-toxicity-in-thyroid-cancer/) - What happens when a cancer diagnosis impacts more than just your health? In this episode, Dr. Carrie Cunningham joins us to explore financial toxicity in thyroid cancer—what it is, why it matters, and how we can measure it. She also shares surprising insights about global policies and the promising role of AI in reducing patient - [Unresectable vs. Resectable Thyroid Cancer (Pt. 2)](https://tiro.expert/2025/07/unresectable-vs-resectable-thyroid-cancer-pt-2/) - What changes when thyroid tumors once considered inoperable become surgical candidates? Dr. Mark Zafereo joins Dr. Dana Hartl to explore how neoadjuvant therapy reshapes surgical timing, decision-making, and long-term care for patients with aggressive thyroid cancer. This discussion uncovers clinical judgment calls, imaging insights & evolving surgical strategies you won't want to miss. - [Unresectable vs. Resectable Thyroid Cancer (Pt. 1)](https://tiro.expert/2025/06/unresectable-vs-resectable-thyroid-cancer-pt-1/) - What makes a thyroid tumor truly unresectable? In this episode, Dr. Dana Hartl speaks with Dr. Mark Zafereo about how molecular testing and targeted neoadjuvant therapies are redefining surgical eligibility for patients with anaplastic thyroid cancer. Listen in as they explore the evolving role of BRAF/MEK inhibitors, imaging strategies, and real-world decision-making in complex cases. - [Around the World in 3 Clinical Case Scenarios (Pt. 2)](https://tiro.expert/2025/05/around-the-world-in-3-clinical-case-scenarios-pt-2/) - In the continuation of this episode of Voices of Wisdom, Dr. Dana Hartl hosts Drs. Fabian Pitoia and Iwao Sugitani for a global discussion on thyroid cancer management. Together, they examine real-world cases and explore differing international approaches to active surveillance, surgery and treatment strategies. Gain insight into how cultural values and evolving guidelines shape - [Radioactive Iodine: Unraveling the Mystery (Part 2)](https://tiro.expert/2025/03/radioactive-iodine-unraveling-the-mystery-part-2/) - In Part 2 of this episode of Voices of Wisdom, Dr. Dana Hartl continues her conversation with Dr. David Pattison, diving deeper into radioactive iodine therapy for thyroid cancer. They discuss the biological mechanisms of I-131, key differences from external beam radiation, and evolving strategies for personalized treatment. Dr. Pattison also explores future advancements, including - [Radioactive Iodine: Unraveling the Mystery](https://tiro.expert/2025/02/radioactive-iodine-unraveling-the-mystery/) - Dr. Dana Hartl speaks with Dr. David Pattison about radioactive iodine therapy for thyroid cancer, breaking down different isotopes, their applications, and the importance of theranostics. They discuss how pre-therapy imaging can help personalize treatment and avoid ineffective therapies. Dr. Pattison also explains the role of dosimetry and how institutions like Royal Brisbane and Women’s - [Démystifier le lien entre la radiation & le cancer de la thyroïde](https://tiro.expert/2025/01/demystifier-le-lien-entre-la-radiation-le-cancer-de-la-thyroide/) - Pour nos francophones, notre animatrice et notre invité (tous deux francophones) ont généreusement enregistré leur interview en anglais et en français. Le Dr Dana Hartl interviewe le Professeur Martin Schlumberger pour démystifier les idées reçues sur le cancer de la thyroïde et ses liens avec les radiations. Ils abordent des facteurs clés tels que la - [Debunking the Connection Between Radiation & Thyroid Cancer](https://tiro.expert/2025/01/debunking-the-connection-between-radiation-thyroid-cancer/) - For French speakers, our host and guest (both fluent in French) generously recorded their interview in English and French. Dr. Dana Hartl interviews Professor Martin Schlumberger to debunk myths about thyroid cancer and its links to radiation. They discuss key factors like radiation dose, age of exposure, and proactive measures that reduce risks, using insights - [Thyroid Cancer & Pregnancy](https://tiro.expert/2024/12/thyroid-cancer-pregnancy/) - In this episode of Voices of Wisdom, Dr. Janice Pasieka hosts Dr. Angela Leung to discuss managing thyroid cancer during pregnancy. They delve into the complexities and reassuring aspects of monitoring thyroid nodules in pregnant women, emphasizing a multidisciplinary approach for optimal care. Dr. Leung shares valuable insights on the timing of surgical interventions and - [Molecular Diagnostics](https://tiro.expert/2024/11/molecular-diagnostics/) - In the latest episode of TIRO’s Voices of Wisdom podcast, Dr. Janice Pasieka hosts Dr. Erik Alexander, a leading endocrinologist from Brigham and Women's Hospital in Boston, to discuss the evolving role of molecular diagnostics in thyroid cancer management. They delve into the types of molecular testing available, particularly Afirma and ThyroSeq version 3, highlighting - [Active Surveillance](https://tiro.expert/2024/08/active-surveillance/) - In this episode of Voices of Wisdom, host Janice Pasieka and expert guest Eyal Robenshtok dive into the revolutionary approach of active surveillance in thyroid cancer treatment. They explore how this method challenges traditional surgery-first strategies, offering valuable insights for clinicians. Discover the criteria for selecting patients for active surveillance and the nuanced considerations that - [Rising Thyroglobulin Levels](https://tiro.expert/2024/07/rising-thyroglobulin-levels/) - Welcome to the inaugural episode of TIRO's Voices of Wisdom podcast, hosted by Dr. Janice Pasieka, a surgical endocrinologist from Calgary. This series promises to be an essential resource for clinicians managing thyroid cancer, providing practical advice through discussions with international experts. In this episode, Dr. Michael Tuttle of Memorial Sloan Kettering shares his insights ## Pages - [Thyroid International Recommendations Online](https://tiro.expert/) - Thyroid specialists from around the world built TIRO for clinicians who treat thyroid cancer & thyroid nodules and shares the latest in care recommendations. - [ATA 2025 Risk of Recurrence Calculator](https://tiro.expert/ata-2025-risk-of-recurrence-calculator/) - ATA 2025 ROR Calculator Reset Copy Summary Initial Risk Dynamic Risk (Post-Op) 1. Histology & Staging Histology PTC FTC / IEFVPTC Oncocytic (OTC) Tumor Size (cm) AJCC T-Stage (Auto) T1 (≤ 2 cm)T2 (2 - 4 cm)T3a (> 4 cm)T3b (Gross ETE Strap)T4 (Gross ETE Major) *Staging auto-updates based on size. Select Gross ETE below - [TIROxMDS](https://tiro.expert/webinars/) - We designed this online series for thyroid clinicians and researchers that includes lectures, journal clubs and tumor boards. Join us every Friday at 8am EST! - [Anatomic Checklist for Thyroid Cancer](https://tiro.expert/recommendations/analysis-tools/) - Anatomic Checklist for Thyroid Cancer Intraoperative Gross Extrathyroid / Extranodal Disease MINIMUM DATA SET Surgical outcome:R0R1R2 Disease status at time of resection?PrimaryRecurrence (Rec) Is distant metastatic disease present?YesNoUnknown If yes, site(s) of disease: Basic Intraoperative Findings for AJCC Staging cT3b: Gross extrathyroid extension invading strap muscles (sternothyroid, thyrohyoid or omohyoid muscles)?YesNo cT4a:YesNo If Yes, check - [What is TIRO?](https://tiro.expert/what-is-tiro/) - TIRO helps medical professionals optimize the care of their patients by guiding them through the existing evidence. - [Initial Staging & Response to Therapy](https://tiro.expert/recommendations/dtc/initial-staging-response-to-therapy/) - After surgery, initial staging begins by collecting patient data & exam results. This helps a physician determine the risk of recurrence & response to therapy. - [Initial Evaluation of Thyroid Nodules](https://tiro.expert/recommendations/dtc/initial-evaluation-of-thyroid-nodules/) - If there is a thyroid nodule, the first step is to get an initial evaluation, a comprehensive physical exam. Here's what to expect during this process. - [Initial Management](https://tiro.expert/recommendations/dtc/initial-management/) - When initially treating a patient with differentiated thyroid cancer, you should determine the best treament options and extent of surgical intervention. - [Systemic Therapy](https://tiro.expert/recommendations/dtc/systemic-therapy/) - In patients with advanced disease and where RAI is no longer an option, multikinase inhibitors and cytotoxic therapy might be options in treatment. - [Tables & Figures](https://tiro.expert/tables-and-figures/) - Our site uses of a wide variety of tables and figures from trusted sources. Explore our library of imagery in diagnostic & treatment of thyroid malignancies. - [Privacy Policy](https://tiro.expert/privacy-policy/) - This Privacy Policy describes Our policies and procedures on the collection, use and disclosure of Your information. - [Terms of Use](https://tiro.expert/terms-of-use/) - Effective Date January 16, 2023 Please read these Terms of Use ("Terms", "Terms of Use") carefully before using the https://tiro.expert website (the "Service") operated by TIRO ("us", "we", or "our"). Your access to and use of the Service is conditioned on your acceptance of and compliance with these Terms. These Terms apply to all visitors, - [Recurrent & Persistent Disease](https://tiro.expert/recommendations/dtc/recurrent-persistent-disease/) - In patients with advanced or recurrent differentiated thyroid cancer, different treatments might be available based on anatomic site and extent of disease. - [Use of Radioactive Iodine](https://tiro.expert/recommendations/dtc/use-of-rai/) - Radioactive Iodine is an important aspect to treatment. Here we outline care needed prior, during and after radioactive iodine therapy. - [Past Webinars](https://tiro.expert/past-webinars/) - Watch prior installments of our online series for thyroid clinicians & researchers. TIROxMDS hosts lectures, journal clubs and tumor boards. Fridays at 8am EST! - [Evaluation of Advanced Disease](https://tiro.expert/recommendations/mtc/evaluation-of-advanced-disease/) - In patients with suspicion of persistent/recurrent disease based on postoperative tests. Radiotherapy and other systemic therapy options might be appropriate. - [Initial Evaluation of Thyroid Nodules Suspicious of MTC](https://tiro.expert/recommendations/mtc/initial-evaluation-of-thyroid-nodules-suspicious-of-mtc/) - Confirming diagnosis is of utmost importance. Here we outline initial procedures & tests that confirm diagnosis of medullary thyroid cancer, prior to treatment. - [Initial Staging & Treatment Planning](https://tiro.expert/recommendations/atc/initial-staging-treatment-planning/) - In anaplastic thyroid cancer, multidisciplinary care and expedited initial evaluations are essential. Learn more about treatment planning for this malignancy. - [Diagnostic Procedures](https://tiro.expert/recommendations/atc/diagnostic-procedures/) - Due to the aggressive nature of anaplastic thyroid cancer, prompt diagnosis is crucial. This section outlines recommended diagnostic procedures for patients. - [Surgical Management](https://tiro.expert/recommendations/mtc/surgical-management/) - Total thyroidectomy is the surgical procedure indicated for patients. This section outlines the surgical options based on individual patient characteristics. - [Management of Specific Clinical Scenarios](https://tiro.expert/recommendations/mtc/management-of-specific-clinical-scenarios/) - Specific clinical scenarios such as familial disease or MEN2A/MEN2B are not rare. Find out why/how ften these scenarios might require a different treatment. - [End of Life Care](https://tiro.expert/recommendations/atc/end-of-life-care/) - Due to the aggressive nature of anaplastic thyroid cancer, it is advisable that early discussions be undertaken about end of life counseling. - [Systemic Therapy](https://tiro.expert/recommendations/atc/systemic-therapy/) - Considering adjuvant treatment can help improve a patient's prognosis. Here we outline the main treatment alternatives in anaplastic thyroid cancer patients. - [Surgical Management](https://tiro.expert/recommendations/atc/surgical-management/) - It is important to evaluate a thyroid cancer patient's prognosis in order to select the best treatment option. Find out when & why surgery should be performed. - [Contact](https://tiro.expert/contact/) - Contact Us We'd love to hear from you. Write Us Follow Us Facebook Twitter Instagram YouTube Our Amazing Sponsors - [Clinical Trial Options](https://tiro.expert/clinical-trial-options/) - Clinical Trial Options Clinical Outline Educational Clips from TIROxMDS Reasons to Enter Patients into Clinical Trials = Primers in Thyroidology = Journal Club Presentation = Case-based Discussion (inc. roundtables) = Grand Rounds Lectureship Care Recommendations Differentiated Thyroid Cancer Initial Evaluation of Thyroid Nodules Initial Management Initial Staging & Response to Therapy Systemic Therapy Use of - [How to Use TIRO](https://tiro.expert/how-to-use-tiro/) - TIRO uses a few unique tools to navigate the breadth of content covered. Learn how to use TIRO. - [Care Recommendations](https://tiro.expert/recommendations/) - The care recommendations are based on published guidance for thyroid nodule and thyroid cancer management. - [Differentiated Thyroid Cancer](https://tiro.expert/recommendations/dtc/) - [Medullary Thyroid Cancer](https://tiro.expert/recommendations/mtc/) - [Anaplastic Thyroid Cancer](https://tiro.expert/recommendations/atc/) - [Legal](https://tiro.expert/legal/) ## Categories - [Uncategorized](https://tiro.expert/category/uncategorized/)