The incidence of papillary thyroid carcinoma (PTC) has increased remarkably over the past few decades. Given the indolent nature of PTC, active surveillance (AS) has been suggested as an alternative management option to immediate surgery in the management of low-risk papillary thyroid microcarcinoma (PTMC). While there is conflicting evidence regarding potential risk factors for disease progression, many groups have demonstrated the efficacy and safety of AS and proposed risk stratification, which can help to select appropriate patients. This review aims to summarize the data regarding low-risk PTMC as well as important considerations of AS.