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The British Thyroid Association (BTA) guidelines published in 2014 recommend selective performing of FNA for suspicious nodules Entinostat solubility dmso to diagnose suspicious thyroid nodules immediately even if it is very small. This pattern is consistent regardless of age and sex except respondents in their thirties. The reason why they choose Mianserin HCl delayed diagnosis is unknown, but might be assumed that it is related with their unstable socioeconomic status at this age group in Korea. One of the remarkable changes made in the new ATA guidelines is to adopt active surveillance as a reasonable alternative option to immediate surgery for PTMC [1]. While the latest BTA guidelines leave place for active surveillance decided by the responsible clinician in the absence of other risk factors, the latest GAES, AACE, AME, and ETA guidelines did not adopt active surveillance [3,4,12]. The concept of active surveillance for PTMC came from observation studies conducted in Japan [13,14]. Although the studies showed that SCR7 purchase careful observation might be a safe and effective alternative to immediate surgical resection, they did not include all PTMCs. Excluded were patients with the presence of regional lymph-node metastasis or distant metastasis, signs or symptoms of invasion to the recurrent laryngeal nerve or trachea, FNA cytologic findings suggesting high-grade malignancy, and tumors located adjacent to the recurrent laryngeal nerve or trachea in their studies. Patient age was significantly related to the progression of PTMC during observation [14]. Clinically significant disease progression, which means tumor growth and/or novel appearance of regional lymph node metastasis, was more frequent in young patients under 40 years old. However, prognosis of PTC cannot be reliably predicted by size only. The cumulative risks of extrathyroidal growth, lymph node metastasis, and distant metastasis of PTCs increased linearly with increasing tumor diameter [15]. As a matter of fact, there are reports in the literature of patients with PTMCs presenting with clinically significant regional or distant metastases who very rarely died of the disease [6,7,8,9]. Even Ito et al.