SAT-332 Active Surveillance for Low-Risk Papillary Thyroid Microcarcinoma: A Web Survey Assessing Clinician Willingness to Adapt

Abstract Disclosure: G. Effraimidis: None. E. Sazakli: None. O. Karapanou: None. K. Saltiki: None. M.A. Michalaki: None. Introduction. Current guidelines emphasize active surveillance (AS) over immediate surgery for low-risk papillary thyroid microcarcinomas (PTMCs). Alternative minimally invasive treatments, such as thermal ablation, are being explored. If thyroidectomy is performed, lobectomy is preferred, and radioactive iodine (RAI) remnant ablation is not routinely recommended for low-risk PTMC patients. Previously, surveys from Brazil, Australia and New Zealand and the United States examined the attitudes of physicians and surgeons toward AS and the management of low-risk PTMCs. Aim. This study aimed to assess the approach of Greek endocrinologists toward AS and the management of low-risk PTMCs. Methods. A web-based survey was conducted among members of the Hellenic Endocrine Society (HES). Two clinical scenarios involving a 60-year-old woman with low-risk PTMC were analyzed. Surveyed endocrinologists were asked whether they would recommend AS, thermal ablation, lobectomy, or total thyroidectomy as primary treatment; and if total thyroidectomy was performed, whether they would recommend RAI ablation therapy. Results. A total of 201 endocrinologists (25% of HES members) participated. As primary treatment for low-risk PTMC, 46.8% recommended total thyroidectomy, 31.3% chose AS, and 20.9% opted for lobectomy and 1.0% selected thermal ablation. If total thyroidectomy was performed, 95% considered RAI ablation unlikely, and only 5% would use RAI. Demographic characteristics, including age, sex, experience, and geographic location, did not significantly influence these choices. The primary reason cited by endocrinologists for non-compliance is skepticism about implementing the guidelines, likely stemming from resource limitations and educational gaps. Conclusion. In this highly representative of the HES members with high response rate survey, one-third of the Greek endocrinologists preferred AS for managing low-risk PTMCs and almost all responded that it is very likely or likely not to use RAI remnant ablation in very low-risk PTMC. This is the first known survey conducted in Europe on AS and the management of low-risk PTMCs. Insights from the survey may help to reduce overtreatment in low-risk PTMC management. Presentation: Saturday, July 12, 2025