PTMC is on the rise. The evidence suggests that this increase in incidence is associated with an increase in diagnostic scrutiny. Therefore, we need to examine how we manage this disease, which in most cases is indolent. Molecular markers will likely, one day, aid in the decision-making of which neoplasms need to be aggressively treated and which may be actively observed. At present, it is safe and effective to manage PTMCs conservatively, with active surveillance only, for appropriate patients, following the use of a risk-stratified, evidence-based approach. With the increased use of diagnostic modalities in the primary care setting, an in-depth understanding of the natural history of PTMC is important in the management of this now common—however, rarely deadly—clinical entity.