While accepted as a viable initial management option for properly selected small (< 1.5 cm) papillary thyroid cancer (PTC), the natural history and clinical outcomes of active surveillance in larger tumors are not well described.

This is a retrospective chart review of patients with PTC > 1.5 cm opting for active surveillance as part of routine clinical care.

In 45 patients with PTC > 1.5 cm (range 1.6-2.9 cm) followed with active surveillance for a median of 4.2 years: 6 patients (13%, 6/45) demonstrated an increase in tumor volume, 5 patients (11%, 5/45) demonstrated newly identified cervical lymph node metastasis. Only 9 patients (20%, 9/45) transitioned to surgical intervention with no evidence of disease, a median of 3.1 years after surgical intervention.

These findings suggest that active surveillance is a viable initial management option in properly selected patients with PTC greater than 1.5 cm in maximal diameter.