Treatment Hotspots and Controversies in Papillary Thyroid Microcarcinoma.

BACKGROUND: The significant global rise in the detection rate of papillary thyroid microcarcinoma (PTMC) has sparked intense debates concerning overdiagnosis and overtreatment. Consequently, therapeutic strategies are shifting from radical surgery toward risk-stratified management, including active surveillance (AS) and minimally invasive techniques (MIT). Core controversies focus on the necessity of surgical intervention, the extent of prophylactic central neck dissection, and selection criteria for MIT versus conventional surgery. METHODS: This review systematically evaluates the comparative evidence on AS, thermal ablation (TA), and surgical treatment for PTMC, highlighting divergent Eastern and Western management philosophies to provide an optimized framework for clinical decision-making. RESULTS: Although AS demonstrates favorable survival benefits and health economic advantages for patients with PTMC, unresolved clinical risks persist. Notably, Chinese guidelines adopt stricter standards compared to the international 10 mm threshold. Among MIT, TA exhibits well-established short-term efficacy; however, recent expert consensus emphasizes a strict therapeutic hierarchy to prevent misuse, given the paucity of long-term recurrence data. CONCLUSION: An individualized framework based on risk stratification is essential for PTMC management, balancing oncological safety and quality of life.