2.

Recommendations for the diagnosis and management of PTMC

Items	Recommendations	Rating
1	Given that the prevalence of PTMC has increased significantly, PTMC should be considered in the diagnosis and treatment of thyroid carcinoma.	A
2	High-frequency ultrasonography is recommended as the first-line imaging modality for the diagnosis of PTMC.	A
3	Ultrasound-guided FNAB is recommended for the further diagnosis of PTMC.	B
4	CEUS and USE are recommended as complementary, but not routine, diagnostic modalities for PTMC.	D
5	Enhanced CT and MRI are recommended as valuable tools for the diagnosis of large metastases and the suspicious invasion of surrounding tissue in PTMC.	B
6	MRI and PET/CT are not recommended as routine diagnostic modalities for PTMC.	E
7	FNAB could be performed to diagnose PTMC when tumor diameter ≥5 mm. The Bethesda system is recommended for malignanct risk classification.	B
8	Testing with auxiliary molecular markers could further improve the accuracy rate of PTMC preoperative diagnosis.	C
9	In the evaluation of suspicious cervical lymph nodes in patients with PTMC, FNA-Tg washout fluid could be selectively tested as an auxiliary diagnostic method but is not recommended as a routine diagnostic method.	I
10	PTMC variants should be reported in the final diagnosis.	C
11	Surgical treatment is recommended for PTMC patients with high-risk factors.	B
12	Close follow-up observation for PTMC patients with low-risk factors could be considered upon the strict selection of indications and the adequate consideration of the patient's preferences.	C
13	Clinical observations should be strictly time limited and documented. High-resolution ultrasound imaging is preferred in follow-up review.	B
14	Thyroid lobectomy+ thmusectomy or total/near-total thyroidectomy is selected depending on the clinical situation and the evaluation of recurrence risk.	A
15	The protection of the recurrent laryngeal nerve, superior laryngeal nerve, and parathyroid gland must be emphasized.	A
16	cN+PTMC patients need lymph node resection.	A
17	Prophylactic central lymph node dissection is recommended for cN0 PTMC patients.	B
18	Prophylactic lateral neck lymph node dissection is not recommended for PTMC patients.	E
19	131I radioablation is not recommended as a routine procedure after PTMC surgery.	E
20	Radioactive iodine (RAI) treatment should be applied individually in accordance with the patient’s specific condition.	B
21	The dosage and the principles of RAI in PTMC are basically the same as those for PTC patients.	A
22	PTMC still requires TSH suppression therapy after surgery, and individualized treatment should be implemented based on the risk of tumor recurrence and the risk of the adverse effects of suppression therapy.	B
23	Long-term follow-up is needed for PTMC patients regardless of surgical or nonsurgical treatment.	A