Active surveillance (AS) has been shown to be a safe approach that can effectively block the transition from overdiagnosis to overtreatment in patients with low-risk papillary thyroid microcarcinoma (PTMC). This study aimed to determine whether the AS approach can be implemented in China and to investigate the population characteristics of Chinese patients who underwent AS.Epidemiological and clinical characteristics and patient adherence were evaluated in 115 patients who underwent AS management as an alternative to immediate surgery for low-risk (or highly suspected) PTMC.The mean patient age was 41.8 (± 10.3) years, with 41.7% and 4.4% of patients < 40 and ≥ 60 years, respectively. The median baseline diameter of the index tumors was 4 (3-6) mm, with 73.0% of tumors being ≤ 5 mm. A total of 84.4% of patients had a junior college, college or graduate degree, and 83.5% were employed in government, public institutions, companies or technical posts. After a median 25-month follow-up, tumor growth ≥ 3 mm occurred in 3 (2.6%) patients, and no new lymph node metastasis occurred. Surgery was performed in 4 patients because of patient preferences rather than disease progression. There was satisfactory adherence in 109 (94.8%) patients in the simulated ideal medical environment.The AS approach can be used as an alternative to low-risk PTMC management in China. Given the difference in epidemiological and clinical characteristics, Chinese institutions should fully consider the features of the Chinese population when developing candidate criteria, surveillance intervals, and follow-up strategies for AS.Copyright © 2022. Published by Elsevier Inc.