{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:46:51Z","timestamp":1785818811231,"version":"3.56.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>For low-risk differentiated thyroid carcinoma (DTC) survivors with excellent or indeterminate response, the 2025 American Thyroid Association (ATA) guidelines endorse assay-specific reference-interval thyrotropin (TSH) targets, potentially simplifying levothyroxine titration versus ATA 2015 fixed cutoffs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess whether endocrinologist and hospital-level characteristics influence levothyroxine treatment adequacy in low-risk DTC with excellent\/indeterminate response, and to compare adequacy under ATA 2015 versus ATA 2025 frameworks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Multicenter, retrospective study including 978 adults managed by 16 endocrinologists. Dynamic risk stratification (DRS) status and serum TSH at last visit defined adequacy: ATA 2015 (0.5\u20132.0 mcU\/ml for excellent; 0.1\u20130.5 mcU\/ml for indeterminate) vs ATA 2025 (within local reference interval for both). Physician and hospital characteristics were compared across adequacy strata. Multilevel logistic regression (random intercept for physician) evaluated patient- (age, follow-up, dose instability) and physician-level predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Under ATA 2015 criteria, 383 of 954 (40.1%) were adequately controlled, compared with 650 of 963 (67.5%) under ATA 2025 criteria. In those with &amp;gt;2 years\u2019 follow-up, adequacy increased from 41.5% (364\/878) to 68.8% (608\/884) from ATA 2015 to ATA 2025. Dose instability independently predicted lower adequacy in both frameworks (ATA 2015: aOR 0.183, 95% CI  0.129\u20130.260; ATA 2025: aOR 0.110, 0.078\u20130.156; both p&amp;lt;0.001). With ATA 2025, additional inverse associations included older age (aOR 0.980\/year; p=0.001), female physician sex (vs male; aOR 0.244; p=0.037), and higher new-patient volume (aOR 0.967\/patient; p=0.009).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adoption of ATA 2025 reference-range TSH targets substantially increases the proportion of low risk DTC survivors classified as adequately treated. Nevertheless, treatment adequacy remains strongly shaped by dose instability and selected provider workload attributes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1820537","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:27:33Z","timestamp":1785817653000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Physician and hospital determinants of levothyroxine treatment adequacy in low-risk papillary thyroid carcinoma"],"prefix":"10.3389","volume":"17","author":[{"given":"Juan J.","family":"D\u00edez","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda","place":["Majadahonda, Spain"]},{"name":"Instituto de Investigaci\u00f3n Sanitaria Puerta de Hierro Segovia de Arana","place":["Majadahonda, Spain"]},{"name":"Department of Medicine, Universidad Aut\u00f3noma de Madrid","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Anda","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Hospital Universitario de Navarra","place":["Pamplona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Alcazar","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria Puerta de Hierro Segovia de Arana","place":["Majadahonda, Spain"]},{"name":"Department of Endocrinology, Hospital Severo Ochoa","place":["Legan\u00e9s, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C.","family":"Galofr\u00e9","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Cl\u00ednica Universidad de Navarra","place":["Pamplona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Familiar","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Hospital Cl\u00ednico San Carlos","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda J.","family":"Pamplona-Civera","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Hospital Royo Villanova","place":["Zaragoza, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Gonz\u00e1lez-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Endocrinology. Hospital Universitario de Cabue\u00f1es","place":["Gij\u00f3n, Spain"]},{"name":"Instituto de Investigaci\u00f3n Sanitaria del Principado de Asturias (ISPA)","place":["Oviedo, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Herrero-Ruiz","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Hospital Universitario de Salamanca","place":["Salamanca, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda R.","family":"Alhambra","sequence":"additional","affiliation":[{"name":"Unidad de Gesti\u00f3n Cl\u00ednica (UGC) Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Universitario Reina Sof\u00eda","place":["C\u00f3rdoba, Spain"]},{"name":"Instituto Maim\u00f3nides de Investigaci\u00f3n Biom\u00e9dica de C\u00f3rdoba (IMIBIC)","place":["C\u00f3rdoba, 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