OBJECTIVES: The 2015 updated American Thyroid Association (ATA) guidelines recommended the option of the following: 1) active surveillance (AS) of some small DTC, 2) performance of less extensive surgery for low-risk DTC, and 3) more selective administration of radioactive iodine (RAI). We sought patient perspectives regarding these changes. METHODS: A on-line 34-item survey was distributed to thyroid cancer patient advocacy organizations and members of the ATA to distribute to patients. Data were collected on demographic and treatment information, opinions about the guideline changes, and patient experience with DTC. Patients were asked “what-if” scenarios on core topics, including AS, extent of surgery, and indications for RAI. RESULTS: Survey responses were analyzed from 1,546 patients with previously treated DTC: 96% had a total thyroidectomy, and 76% underwent treatment with RAI. Response rate is unknown given the method of distribution. If no change in overall cancer outcome, 39% of respondents would have considered a lobectomy over total thyroidectomy; 35% would have opted for AS; and 41% would have chosen to forego RAI. 64% of respondents wanted more time with their clinicians when making decisions about extent of operation. 58% of patients experienced significant side effects with RAI treatment, and 30% felt that the risks of treatment were not well explained. 80% felt that AS would not be overly burdensome, and preservation of quality of life was the main reason cited for choosing AS. CONCLUSIONS: Patient perspective regarding choice in management of low-risk DTC varies widely and a large proportion of DTC patients would change aspects of their care if oncologic outcomes were equivalent.