Who Leads, Who Treats, What Dose? European Paediatric DTC Practice – an EXPeRT survey

Objective: To map real-world management of paediatric differentiated thyroid carcinoma (DTC) across Europe and identify targets for harmonisation. Design: Cross-sectional, web-based survey of centres providing paediatric DTC care. Methods: One consolidated response per centre was requested from a clinician overseeing paediatric DTC. The instrument covered centre profile/multidisciplinary tumour board organisation; staging and guideline use; risk stratification and dynamic response; diagnostics; surgery/lymph node management; radioiodine therapy (RAIT) policy and activity selection; Thyroid-Stimulating Hormone targets, follow-up, shared-care/transition. Analyses were descriptive at centre level. Results: Forty-two centres from 18 countries participated. Among centres answering each item, university/academic hospitals ≈75%; paediatric age cut-off ≤18 y ≈70%; dedicated multidisciplinary tumour board (MDT) ≈60%. Staging systems varied and the primary guidance was mixed (∼30%), American Thyroid Association (ATA) 2015 (∼25-30%), national (∼20-25%), or European Thyroid Association (ETA) 2022 (∼10-15%). Dynamic response-to-therapy categories were commonly used. For unilateral presumed low-risk disease, hemithyroidectomy was the usual initial surgery in about two-thirds to three-quarters of centres, total thyroidectomy was less frequent. For low-risk patients, RAIT policy split between de-escalation (≈55%) and risk-adapted use (≈45%). When given, activity was determined by weight, dosimetry, or fixed empiric approaches. Country-level patterns were evident (ETA- vs ATA-leaning/national environments). Conclusions: Across Europe, centres broadly endorse risk-adapted care but diverge at key decision nodes-extent of surgery, formal risk framework, and RAIT in low-risk disease-reflecting guidance plurality and organisational context. Leveraging existing infrastructures offers pragmatic avenues to reduce unwarranted variation while generating paediatric-specific evidence to refine recommendations.