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Journal Article Practice Guideline Ppublish 1 citation

PubMed: 40598902 DOI: 10.3803/EnM.2025.2461

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

Endocrinol Metab (Seoul) 40(3):307-341

Authors: Eun Kyung Lee, Min Joo Kim, Seung Heon Kang, Bon Seok Koo, Kyungsik Kim, Mijin Kim, Bo Hyun Kim, Ji-Hoon Kim, Shinje 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

Affiliations

  • Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea.
  • Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • Department of Otolaryngology, Chungbuk National University Hospital, Cheongju, Korea.
  • Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Korea.
  • Department of Occupational and Environmental Medicine, Ajou University School of Medicine, Suwon, Korea.
  • Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
  • Department of Radiology, Seoul National University Hospital, Seoul, Korea.
  • Department of Internal Medicine, Hanyang University Hospital, Seoul, Korea.
  • Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea.
  • Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
  • Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
  • Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
  • Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Sejong, Korea.
  • Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea.
  • Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
  • Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea.
  • Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
  • Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

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.

MeSH

Thyroid Cancer, Papillary, Laryngeal Nerves, Lymph Nodes, Thyroid Gland, Neoplasm Metastasis, Lymph, Trachea, Recurrent Laryngeal Nerve, Endocrine System Diseases

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