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Background:  Clinical practice guidelines have endorsed both active surveillance and surgery as viable management options for papillary thyroid microcarcinoma (PTMC). However, patients' perceptions on the options have rarely been addressed.  Methods:  A cross-sectional survey was conducted on 50 patients with PTMC who were under either active surveillance ( n  = 20) or postoperative follow-up ( n  = 30). The primary outcome was anxiety, which was measured using the State-Trait Anxiety Inventory (STAI). A questionnaire that comprised six items about PTMC-related symptoms and concerns, which were measured with a visual analog scale, was also administered. Cohen's d effect size was calculated to express group differences. Multiple regression analysis was used to examine the relationships between state anxiety and other variables.  Results:  The median age and observation period were 61.5 years (range, 40-83 years) and 4.1 years (range, 0-8.6 years), respectively. The female/male ratio was 38/12. Compared with the surgery group, the active surveillance group showed higher scores in both state anxiety and trait anxiety, with corresponding effect sizes of 0.55 (confidence interval [CI] -0.03 to 1.1; p  = 0.068) and 0.63 (CI 0.02-1.2; p  = 0.037), respectively. Trait anxiety (β = 0.83) and observation time (β = -1.57) were the significant predictors of state anxiety. Moderate effect sizes were observed for "discomfort in the neck" (-0.53; CI -1.11 to 0.04); "weak voice" (-0.46; CI -1.03 to 0.12); and "nervous about neck appearance" (-0.64; CI -1.23 to -0.07), in favor of active surveillance.  Conclusions:  State anxiety among patients with PTMC seemed to be a reflection of an individual's trait rather than management. Understanding the patients' view appears to be key to improve shared decision-making.

Patients' View on the Management of Papillary Thyroid Microcarcinoma: Active Surveillance or Surgery