Active surveillance for low-risk papillary thyroid microcarcinoma: a web-survey on clinician readiness for change.

Abstract

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.

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 in this case, whether they would recommend RAI ablation.

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, 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 noncompliance is skepticism about implementing the guidelines, likely stemming from resource limitations and educational gaps.

Conclusion: One-third of Greek endocrinologists prefer AS for managing low-risk PTMCs. More time and effort may be needed to further shift their clinical approach. Insights from our web survey aim to reduce overtreatment in low-risk PTMC management.