2025 Korean Thyroid Association Clinical Management Guideline on Active Surveillance for Low-Risk Papillary Thyroid Carcinoma

• Published in: Endocrinology and metabolism (Seoul) Vol. 40; no. 3; pp. 307 - 341
• Main Authors: Lee, Eun Kyung, Kim, Min Joo, Kang, Seung Heon, Koo, Bon Seok, Kim, Kyungsik, Kim, Mijin, Kim, Bo Hyun, Kim, Ji-hoon, Moon, Shinje, Back, Kyorim, Song, Young Shin, Ahn, Jong-hyuk, Ahn, Hwa Young, Won, Ho-Ryun, Yoo, Won Sang, Lee, Min Kyoung, Lee, Jeongmin, Lee, Ji Ye, Jung, Kyong Yeun, Jung, Chan Kwon, Cho, Yoon Young, Lim, Dong-Jun, Kim, Sun Wook, Park, Young Joo, Kim, Jee Soo
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Endocrine Society 01.06.2025; 대한내분비학회
• Subjects: active surveillance; Carcinoma, Papillary - pathology; Disease Management; guideline; Humans; korean; papillary thyroid microcarcinoma; Practice Guidelines as Topic - standards; Republic of Korea - epidemiology; Review; Societies, Medical; Thyroid Cancer, Papillary - diagnosis; Thyroid Cancer, Papillary - pathology; Thyroid Cancer, Papillary - therapy; thyroid neoplasms; Thyroid Neoplasms - diagnosis; Thyroid Neoplasms - pathology; Thyroid Neoplasms - therapy; Watchful Waiting - methods; Watchful Waiting - standards; 내과학; Republic of Korea; Thyroid neoplasms; Guideline; Korean; Active surveillance; Papillary thyroid microcarcinoma
• ISSN: 2093-596X; 2093-5978; 2093-5978
• DOI: 10.3803/EnM.2025.2461

The increasing detection of papillary thyroid microcarcinoma (PTMC) has raised concerns regarding overtreatment. For low-risk PTMC, either immediate surgery or active surveillance (AS) can be considered. To facilitate the implementation of AS, the Korean Thyroid Association convened a multidisciplinary panel and developed the first Korean guideline. AS is recommended for adults with pathologically confirmed Bethesda V–VI PTMC who have no clinical evidence of lymph node or distant metastasis, gross extrathyroidal extension, invasion of the trachea or recurrent laryngeal nerve, or aggressive histology. A baseline assessment requires high-resolution neck ultrasound performed by experienced operators to exclude extrathyroidal extension, tracheal or recurrent laryngeal nerve invasion, and lymph node metastasis; contrast-enhanced neck computed tomography is optional. Patient characteristics, including age, comorbidities, and the capacity for long-term follow-up, should be thoroughly assessed. Shared decision-making should carefully weigh the benefits and risks of surgery versus AS, considering expected oncologic outcomes, potential complications, quality of life, anxiety, medical costs, and patient preference. Follow-up involves neck ultrasound and thyroid function tests every 6 months for 2 years and annually thereafter. Disease progression, defined as significant tumor growth or newly detected nodal or distant metastasis, warrants surgery. Despite remaining uncertainties, this guideline provides a structured framework to ensure oncologic safety and supports patient-centered AS.