{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T11:11:12Z","timestamp":1789125072109,"version":"build-2803163510"},"reference-count":27,"publisher":"Bioscientifica","issue":"5","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":52,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Over the past decade, the management of papillary thyroid carcinoma (PTC) has become increasingly individualized, with less aggressive approaches recommended for low-risk diseases. However, the real-world implementation of these recommendations remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to assess real-world management patterns and therapeutic preferences regarding surgical extent, radioactive iodine (RAI) use, and thyrotropin (TSH) levels in low- and low-to-intermediate-risk PTC through a nationwide survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A nationwide web-based survey was conducted among members of the Greek Endocrine Society (25% response rate) between November 2023 and April 2024. The questionnaire comprised demographic items, 12 clinical scenarios, and a final section exploring general reasons for nonadherence to clinical guidelines; this report focuses on eight scenarios related to low- and low-to-intermediate-risk papillary thyroid carcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For an 18 mm intrathyroidal low-risk PTC, 67.7% of respondents recommended total thyroidectomy, while 51.8% favored adjuvant RAI. When reclassified as low-to-intermediate risk, 92.5% endorsed RAI, often at higher doses (70 mCi), particularly among more experienced and those practicing in large cities. TSH suppression targets in case of excellent response varied: nearly half selected 0.5\u20132.0 \u03bcU\/mL for low-risk PTC, but most favored tighter suppression (0.1\u20130.5 \u03bcU\/mL) in low-to-intermediate-risk scenarios. Senior endocrinologists prefer traditional approaches. Barriers to guideline adherence included limited access to molecular and ultrasonography testing, a shortage of experienced surgeons outside major centers, and skepticism regarding guideline safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings underscore persistent practice variation driven by professional experience and local healthcare infrastructure, underscoring the need for targeted local implementation strategies, particularly outside major urban centers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/ec-25-0796","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T11:34:51Z","timestamp":1777289691000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-10","source":"Crossref","is-referenced-by-count":1,"title":["De-escalation implementation in low-risk papillary thyroid cancer: a nationwide survey"],"prefix":"10.1530","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7313-8391","authenticated-orcid":true,"given":"Grigoris","family":"Effraimidis","sequence":"first","affiliation":[{"name":"Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece 1"},{"name":"Department of Endocrinology and Metabolic Diseases, Larissa University Hospital, Larissa, Greece 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Sazakli","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, School of Health Science, University of Patras, Patras, Greece 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Karapanou","sequence":"additional","affiliation":[{"name":"Endocrine Department, NIMTS Veteran\u2019s Hospital, Athens, Greece 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Saltiki","sequence":"additional","affiliation":[{"name":"Endocrine Unit, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece 5"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2073-8523","authenticated-orcid":true,"given":"Marina A","family":"Michalaki","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, School of Health Science, University of Patras, Patras, Greece 3"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"2026091106561867000_bib1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines task 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