{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T12:57:48Z","timestamp":1776776268238,"version":"3.51.2"},"reference-count":32,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer and is generally associated with an excellent prognosis. Historically, treatment strategies were uniform and frequently aggressive, including total thyroidectomy and routine radioiodine ablation, even in low-risk cases. Current Perspective: Over the past decade, the management of PTC has shifted toward a de-escalation paradigm. This transition is driven by high evidence showing that the majority of PTCs follow an indolent course, with low recurrence and mortality rates. As a result, there is increasing emphasis on tailoring the extent of surgery and adjuvant therapy to individual patient risk profiles. Active surveillance, hemithyroidectomy, and selective use of radioiodine now represent valid alternatives to traditional radical approaches, particularly for low-risk tumors. Clinical Implications: The goal of this evolution is to balance oncologic safety with quality of life, reducing overtreatment and minimizing long-term complications such as hypoparathyroidism or recurrent laryngeal nerve injury. Personalized treatment decisions are now guided by tumor biology, molecular markers, and refined risk stratification systems. Conclusions: This article will review the current evidence supporting this shift, highlight the challenges of implementation in clinical practice, and discuss future trends in the management of papillary thyroid carcinoma.<\/jats:p>","DOI":"10.3390\/cancers18081317","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T11:42:45Z","timestamp":1776771765000},"page":"1317","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Papillary Thyroid Carcinoma in the Era of De-Escalation: Toward Personalized and Less Aggressive Management"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9562-8276","authenticated-orcid":false,"given":"Joaquin","family":"Gomez-Ramirez","sequence":"first","affiliation":[{"name":"Endocrine Surgery Unit, Department of General and Digestive Surgery, Instituto de Investigaci\u00f3n Hospital Universitario La Paz (IdiPAZ), 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raquel Arranz","family":"Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Endocrine Surgery Unit, Department of General and Digestive Surgery, Instituto de Investigaci\u00f3n Hospital Universitario La Paz (IdiPAZ), 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz","family":"L\u00f3pez de la Torre","sequence":"additional","affiliation":[{"name":"Endocrine Surgery Unit, Department of General and Digestive Surgery, Instituto de Investigaci\u00f3n Hospital Universitario La Paz (IdiPAZ), 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa York","family":"Pineda","sequence":"additional","affiliation":[{"name":"Endocrine Surgery Unit, Department of General and Digestive Surgery, Instituto de Investigaci\u00f3n Hospital Universitario La Paz (IdiPAZ), 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0310-7095","authenticated-orcid":false,"given":"Paola","family":"Parra Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Endocrinology and Nutrition Department, Hospital Universitario La Paz, 28046 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/00005792-197705000-00001","article-title":"Papillary thyroid carcinoma: The impact of therapy in 576 patients","volume":"56","author":"Mazzaferri","year":"1977","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/0002-9343(94)90321-2","article-title":"Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer","volume":"97","author":"Mazzaferri","year":"1994","journal-title":"Am. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1001\/jama.295.18.2164","article-title":"Increasing incidence of thyroid cancer in the United States, 1973\u20132002","volume":"295","author":"Davies","year":"2006","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"f4706","DOI":"10.1136\/bmj.f4706","article-title":"Thyroid cancer: Zealous imaging has increased detection and treatment of low-risk tumors","volume":"347","author":"Brito","year":"2013","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1056\/NEJMp1604412","article-title":"Worldwide thyroid-cancer epidemic?","volume":"375","author":"Vaccarella","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer","volume":"26","author":"Haugen","year":"2016","journal-title":"Thyroid"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1177\/10507256251363120","article-title":"2025 American Thyroid Association management guidelines for adult patients with differentiated thyroid cancer","volume":"35","author":"Ringel","year":"2025","journal-title":"Thyroid"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1056\/NEJMoa2111953","article-title":"Thyroidectomy without radioiodine in patients with low-risk thyroid cancer","volume":"386","author":"Leboulleux","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/S2213-8587(24)00276-6","article-title":"Thyroidectomy without radioiodine in patients with low-risk thyroid cancer: 5 years of follow-up of the prospective randomised ESTIMABL2 trial","volume":"13","author":"Leboulleux","year":"2025","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Yang, C., Luo, D., Xie, J., Zou, Y., Chen, F., Yang, W., Zeng, L., and Liu, J. (2025). Is radioiodine necessary for patients with low-risk differentiated thyroid cancer after thyroidectomy: A pooled analysis of ESTIMABL2 and IoN trials. Front. Onco., 15.","DOI":"10.3389\/fonc.2025.1670978"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1111\/obr.12321","article-title":"Adiposity and risk of thyroid cancer: A systematic review and meta-analysis","volume":"16","author":"Schmid","year":"2015","journal-title":"Obes. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.cell.2014.09.050","article-title":"Integrated genomic characterization of papillary thyroid carcinoma","volume":"159","author":"Agrawal","year":"2014","journal-title":"Cell"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"156112","DOI":"10.1016\/j.prp.2025.156112","article-title":"Clinicopathological and molecular characteristics of papillary thyroid carcinoma with BRAF V600E and TERT promoter co-mutations","volume":"272","author":"Liu","year":"2025","journal-title":"Pathol. Res. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s12022-025-09859-y","article-title":"Prevalence and clinical impact of BRAF p.V600E mutation in papillary thyroid carcinoma","volume":"36","author":"Brumfield","year":"2025","journal-title":"Endocr. Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s12022-022-09707-3","article-title":"Overview of the 2022 WHO classification of thyroid neoplasms","volume":"33","author":"Baloch","year":"2022","journal-title":"Endocr. Pathol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/s00268-009-0303-0","article-title":"An observational trial for papillary thyroid microcarcinoma in Japanese patients","volume":"34","author":"Ito","year":"2010","journal-title":"World J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1089\/thy.2017.0227","article-title":"Insights into the management of papillary microcarcinoma of the thyroid","volume":"28","author":"Miyauchi","year":"2018","journal-title":"Thyroid"},{"key":"ref_18","first-page":"152","article-title":"Active surveillance for low-risk thyroid cancers: A review of current practice guidelines","volume":"39","author":"Kim","year":"2024","journal-title":"Endocrinol. Metab."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.surg.2017.03.028","article-title":"Estimation of the lifetime probability of disease progression of papillary microcarcinoma during active surveillance","volume":"163","author":"Miyauchi","year":"2018","journal-title":"Surgery"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1002\/bjs5.50359","article-title":"Hemithyroidectomy versus total thyroidectomy for well-differentiated T1\u20132 N0 thyroid cancer: Systematic review and meta-analysis","volume":"4","author":"Botti","year":"2020","journal-title":"BJS Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e19073","DOI":"10.1097\/MD.0000000000019073","article-title":"Total thyroidectomy versus lobectomy for papillary thyroid cancer: A systematic review and meta-analysis","volume":"99","author":"Zhang","year":"2020","journal-title":"Medicine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1002\/ohn.70009","article-title":"Lobectomy versus total thyroidectomy across 2015 ATA low-to-intermediate-risk papillary thyroid carcinoma","volume":"173","author":"Wong","year":"2025","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.21037\/gs-2025-364","article-title":"Hemithyroidectomy versus total thyroidectomy for differentiated thyroid cancer: Systematic review and meta-analysis","volume":"14","author":"Hao","year":"2025","journal-title":"Gland. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"109937","DOI":"10.1016\/j.surg.2025.109937","article-title":"Total thyroidectomy versus lobectomy for unilateral papillary thyroid cancer with lateral lymph node metastasis: Systematic review and meta-analysis","volume":"190","author":"Wu","year":"2025","journal-title":"Surgery"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1245\/s10434-024-16590-1","article-title":"Continuing De-escalation Trends: Is Adjuvant Radioactive Iodine Administration Truly Needed for Papillary Thyroid Carcinoma with Limited Cervical Disease?","volume":"32","author":"Goldfarb","year":"2025","journal-title":"Ann. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1001\/jamaoto.2022.0621","article-title":"Complication rates of total thyroidectomy vs hemithyroidectomy for papillary thyroid microcarcinoma: A systematic review and meta-analysis","volume":"148","author":"Hsiao","year":"2022","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"R199","DOI":"10.1530\/EJE-15-0481","article-title":"Central neck dissection: A step forward in the treatment of papillary thyroid cancer","volume":"173","author":"Lorente","year":"2015","journal-title":"Eur. J. Endocrinol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"109258","DOI":"10.1016\/j.surg.2025.109258","article-title":"Prophylactic central neck dissection in clinically node-negative papillary thyroid carcinoma: 10-year impact on outcomes","volume":"181","author":"Papini","year":"2025","journal-title":"Surgery"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/ans.19210","article-title":"Effectiveness of prophylactic central compartment neck dissection following hemithyroidectomy in papillary thyroid cancer: A meta-analysis","volume":"95","author":"Zhao","year":"2025","journal-title":"ANZ J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3985","DOI":"10.1007\/s00464-017-5433-0","article-title":"Robotic thyroidectomy versus conventional open thyroidectomy for thyroid cancer: Systematic review and meta-analysis","volume":"31","author":"Pan","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"108469","DOI":"10.1016\/j.ejso.2024.108469","article-title":"Remote-access and minimally invasive video-assisted approaches in lateral neck dissection for papillary thyroid carcinoma: Systematic review and network meta-analysis","volume":"50","author":"Nguyen","year":"2024","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"37401","DOI":"10.1038\/s41598-025-21307-9","article-title":"Assessing quality of life in papillary thyroid cancer: SF-36 versus ThyPRO questionnaire","volume":"15","author":"Kaya","year":"2025","journal-title":"Sci. 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