Endocrine Abstracts

JOINT1093

Objectives: The majority of patients with a low-risk DTC has a favorable outcome. Consensus statements and recent prospective studies do not recommend RAI-ablation for low-risk microcarcinomas (≤10 mm). However, RAI-ablation strategy for other low-risk PTC cases remains controversial and the therapeutic policy varies significantly among endocrinologists.

Aim: To evaluate treatment strategies of Greek endocrinologists for low- and low-to-intermediate-risk PTC in terms of RAI-ablation.

Methods: Between November 2023 and April 2024, a web-based survey was conducted among members of the Hellenic Endocrine Society (HES). Four clinical scenarios involving a 60-year-old patient with a low-risk PTC were analysed. The scenarios varied according to primary tumor size (≤ or >1 cm) and the presence or not of either postoperative cervical lymph node (LN) involvement or minimal extrathyroidal extension (ETE). The scenarios addressed questions regarding the extent of surgery, the decision for postoperative RAI-ablation and the appropriate RAI dose if indicated.

Results: A total of 201 endocrinologists (25% of HES members) participated in the survey. For low-risk PTC patients, responses varied by tumor size: for 7 mm tumors, the majority (95.0%) did not recommend RAI ablation, whereas for 18 mm tumors, 51.8% recommended it. Among those who opted for RAI ablation, the recommended doses were 30 mCi (36.5%), 50 mCi (35.6%), 70 mCi (3.5%), and 100 mCi (14.4%). For low- to intermediate-risk PTC cases with either three microscopic LN metastases (1–2 mm) or minimal ETE, but no other high-risk features, most endocrinologists (92.5%) favoured RAI ablation/adjuvant therapy. Their preferred doses were 30 mCi (13%), 50 mCi (26.6%), 70 mCi (31.2%), and 100 mCi (29.2%).

Conclusions: Greek endocrinologists continued to favour postoperative RAI therapy for low-risk and low-to-intermediate-risk T1b PTC, often at high doses—a concerning trend. These findings highlight the need for more randomized controlled trials, clearer guidelines and educational programs to ensure consistent and evidence-based care.