The tall cell variant of papillary thyroid cancer generally has a worse prognosis compared with the classical variant. Thyroid GuidePx is a genomic classifier capable of classifying papillary thyroid cancer into 3 molecular subtypes using fine-needle aspirate. Type 1 and 2 have low recurrence rates, particularly in early tumors (1–4 cm and N0). Type 3 is characterized by aggressive biology and high recurrence rates regardless of size and lymph node status. The study examines the interaction of tall cell variant histology with Thyroid GuidePx risk stratification.