Currently, treatment decisions for low-risk micro thyroid cancer (TC) are arguably some of the most challenging in thyroidology. Active surveillance has emerged as an important option for low-risk micro TC. Multiple patient and physician factors affect the final selection, adherence to active surveillance or definitive conservative surgery. While baseline clinical criteria are used to identify candidates for this approach, it is important to identify and understand other forces that may influence the management of low-risk micro TC with active surveillance.