The dramatic rise in thyroid cancer incidence over recent decades, coupled with relatively stable mortality rates, has prompted a reassessment of the management strategies for this malignancy. Papillary thyroid carcinoma (PTC) accounts for the vast majority of thyroid cancer cases, with a significant proportion classified as low-risk thyroid carcinomas (LRTCs). The American Thyroid Association (ATA) guidelines define LRTCs as intrathyroidal tumors without evidence of metastasis or adverse prognostic factors such as extrathyroidal extension and aggressive subtypes of thyroid cancer. Most small LRTCs have an exceptionally favorable long-term prognosis, with 5-year survival rates approaching 100%. While surgery remains the primary treatment recommended by several guidelines, nonsurgical options such as active surveillance (AS) and percutaneous ablation have emerged as viable alternatives for patients with LRTC. In the modern era, striking a balance between the extent of treatment and its impact on quality of life is of paramount importance when managing LRTC. Although existing studies compare specific treatments, a comprehensive review synthesizing the specific indications for selecting treatments in LRTC is lacking. This chapter aims to provide an in-depth analysis of the various management options for thyroid LRTC, offering insights to guide clinical decision-making.