2025 Korean Thyroid Association Clinical Management Guideline on Active Surveillance for Low-Risk Papillary Thyroid Carcinoma
10.11106/ijt.2025.18.1.30
- Author:
Eun Kyung LEE
1
;
Min Joo KIM
;
Seung Heon KANG
;
Bon Seok KOO
;
Kyungsik KIM
;
Mijin KIM
;
Bo Hyun KIM
;
Ji-hoon KIM
;
Shin Je MOON
;
Kyorim BACK
;
Young Shin SONG
;
Jong-hyuk AHN
;
Hwa Young AHN
;
Ho-Ryun WON
;
Won Sang YOO
;
Min Kyoung LEE
;
Jeongmin LEE
;
Ji Ye LEE
;
Kyong Yeun JUNG
;
Chan Kwon JUNG
;
Yoon Young CHO
;
Dong-Jun LIM
;
Sun Wook KIM
;
Young Joo PARK
;
Dong Gyu NA
;
Jee Soo KIM
Author Information
1. Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
- Publication Type:REVIEW ARTICLE
- From:International Journal of Thyroidology
2025;18(1):30-64
- CountryRepublic of Korea
- Language:English
-
Abstract:
The increasing detection of papillary thyroid microcarcinoma (PTMC) has raised concerns about overtreatment.For low-risk PTMC, either immediate surgery or active surveillance (AS) can be considered. To support AS implementation, the Korean Thyroid Association convened a multidisciplinary panel and developed the first Korean guideline. AS is recommended to adults with pathologically proven Bethesda V-VI PTMC without clinical evidence of lymph node or distant metastasis, gross extrathyroidal extension, tracheal or recurrent laryngeal nerve invasion, or aggressive histology. Baseline assessment requires high‑resolution cervical ultrasound by experienced operators to rule out extrathyroidal extension, tracheal or recurrent laryngeal nerve invasion, and lymph node metastasis;contrast‑enhanced neck computed tomography is optional. Patient characteristics such as age, comorbidities, and capacity for long-term follow-up should be assessed. Shared decision-making should weigh the benefits and risks of surgery and AS, expected oncologic outcomes, complications, quality of life, anxiety, medical cost, and patient preference. Follow-up includes cervical ultrasound and thyroid function test every six months for two years, then annually. Disease progression, defined as significant tumor growth or newly detected nodal or distant metastasis, warrants surgery. Despite remaining uncertainties, this guideline offers a framework to ensure oncologic safety and support patient-centered active surveillance.
