Image-guided microwave ablation has been recommended as an optional minimally invasive treatment for papillary thyroid microcarcinoma for patients who have psychological burden on cancer and refuse surgical resection. Studies have reported promising results of microwave ablation in the treatment of papillary thyroid microcarcinoma, and it is considered an intermediate option between surgery and active surveillance. In the following chapter, we review the mechanism equipment, indications, patient preparation, procedures, clinical results, and complications of microwave ablation on papillary thyroid microcarcinoma and specifically illustrate the treatment of cancers in particular locations.