Open Access

Michaela Kuhlen, Jelena Roganivic, Samuele Naviglio, Fredrik Baecklund, Rachel Bello, Tal Ben-Ami, Luca Bergamaschi, Ernest Bilic, Ewa Bien, Manuel João Brito, Alicia Castañeda, Maja Cesen Mazic, Nuno Jorge dos Reis Farinha, Aleksandra Jovanovska, Ronald de Krijger, Maria Debora de Pasquale, Rossella Elisei, Gema Grau Bolado, Gabriela Guillén, Magalie Haissaguerre, Dana Hartl, Jorge Huerta-Aragonés, Malgorzata A. Krawczyk, Livia Lamartina, Filipa Leite, Valeriano Leite, Ricardo López Almaraz, Nevena Manevska, Ludovic Mansuy, Evelina Miele, Elin Hallan Naderi, Thilde Nordmann Winther, Isabelle Oliver Petit, Zeynep Alev Özön, Marta Giorgia Podda, Apostolos Pourtsidis, Yves Reguerre, Maria Sandström, Dominik T. Schneider, Saniye Ekinci, Jasna Suput Omladic, Beata Sztangierska, Cecile Verite, Nicolas Waespe, Kee Howe Wong, Bilgehan Yalcin, Michael Abele, Gianni Bisogno, Daniel Orbach, Ines B. Brecht, Calogero Virgone, Antje Redlich

• 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%), AmericanObjective: 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.…