Thermal ablation for papillary thyroid microcarcinoma: Some clarity amid controversies

The increasing incidence of papillary thyroid microcarcinoma (PTMC) has become a global challenge. Because of its indolent nature, active surveillance (AS) has been proposed as a treatment option in selected PTMC patients to prevent surgery-related complications. However, only a few patients with PTMC receive the AS approach because of the serious psychological burden following the “cancer” diagnosis and the uncertainty of the timing for metastatic dissemination. Ultrasound (US)-guided thermal ablation can bridge the gap in the treatment options of PTMC patients who wish for a minimally invasive management approach. However, it has acquired only marginal attention from the thyroid guideline societies because of concerns regarding incomplete elimination. The recently published guidelines from the European Thyroid Association-Cardiovascular and Interventional Radiological Society of Europe and the American Head Neck Society Endocrine Section -initiated global consensus provide the most definitive evidence and essential foundational experience to address the long-term controversy over US-guided thermal ablation for low-risk PTMC patient management and facilitate the responsible global dissemination of minimally invasive strategies.