SAT-333 Management Preferences for Low- and Low-to-Intermediate-Risk Papillary Thyroid Carcinoma Among Greek Endocrinologists: Insights from a Web-Based Survey

Abstract Disclosure: G. Effraimidis: None. E. Sazakli: None. O. Karapanou: None. K. Saltiki: None. M.A. Michalaki: None. Background. The management of low- and low-to-intermediate-risk papillary thyroid carcinoma (PTC) varies significantly, reflecting the complexity of balancing treatment efficacy with minimizing overtreatment. This study aimed to investigate the clinical decision-making of Greek endocrinologists regarding these cases using hypothetical scenarios. Aim. To evaluate the management preferences of Greek endocrinologists for low- and low-to-intermediate-risk PTC, focusing on surgical options, postoperative radioactive iodine therapy (RAI), RAI dosing, and TSH suppression targets. Methods. A web-based survey was conducted among members of the Hellenic Endocrine Society (HES), presenting eight clinical scenarios involving a 60-year-old woman with an 18 mm PTC. The scenarios addressed questions regarding the surgical management (lobectomy vs. total thyroidectomy), the use of postoperative RAI based on risk factors such as lymph node involvement and microscopic extrathyroidal extension, the appropriate dose of RAI if indicated, and the optimal TSH levels. Logistic regression analyses explored associations between participant characteristics (e.g., experience, location) and responses. Results. A total of 201 endocrinologists (25% of HES members) participated. For an 18 mm intraparenchymal low-risk PTC, most (67.7%) recommended total thyroidectomy, with fewer suggesting total thyroidectomy with prophylactic central lymph node dissection (22.4%) or lobectomy (9.9%). Postoperatively, 51.8% favored RAI administration, with 54.2% preferring a low dose of 30 mCi. The preferred TSH targets were evenly distributed between 0.1-0.5 μU/mL (44.8%) and 0.5-2.0 μU/mL (46.3%). Experienced endocrinologists were significantly more likely to recommend RAI (Odds Ratio, OR = 3.5, 95% CI: 1.6, 8.1) and the stricter TSH goal of 0.1-0.5 μU/mL (OR = 4.4, 95% CI: 1.7, 11.3). For an 18 mm low-to-intermediate-risk PTC with either 3 microscopically infiltrated lymph nodes or microscopic extrathyroidal extension and no other high-risk features, 71.1% and 67.6%, respectively, were “very likely” to recommend RAI. The RAI dose was evenly distributed (30.8% for 70 mCi, 28.4% for 100 mCi, and 26.9% for 50 mCi). The most preferable TSH target was 0.1-0.5 μU/mL (44.8%), while a stricter TSH suppression target (<0.1 μU/mL) was preferred by 26.9%, particularly among more experienced endocrinologists (OR = 4.3, 95% CI: 1.3, 15.0) and those practicing in large cities (OR =2.1, 95% CI: 1.0 - 4.4). Conclusions. Greek endocrinologists demonstrate variability in managing low- and low-to-intermediate-risk PTC, particularly regarding RAI use, dose, and TSH targets. Experience and geographical location significantly influence stricter treatment preferences. These findings highlight the need for clearer guidelines and educational programs to ensure consistent and evidence-based care. Presentation: Saturday, July 12, 2025