In adults, papillary thyroid microcarcinoma (PTMC: tumors ≤1 cm) is now the most common form of thyroid carcinoma [1–4]. In children, TMC is an entity not often discussed since young patients are known to present with more extensive disease and are more often the focus of discussion [5,6]. The good news is that the incidence of PTMC in children is decreasing . Nevertheless, given the potential morbidity from thyroid surgery, the potential need for thyroid suppression during important times of growth and development, and long-term quality of life, the management of PTMCs in children needs to be addressed. There are no guidelines or level I studies on the management of these patients. Our goal as clinicians should be to offer these generally low-risk patients a management strategy with the least morbidity, fewest complications, best long-term cancer control and quality of life.