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BACKGROUND: The traditional management of papillary thyroid cancer (PTC) is thyroidectomy (total or partial removal of the thyroid). Active surveillance (AS) may be considered as an alternative option for small, low risk PTC. AS involves close follow-up (including regularly scheduled clinical and radiological assessments), with the intention of intervening with surgery for disease progression or patient preference. METHODS: This is a protocol for a prospective, observational, long-term follow-up multi-centre Canadian cohort study. Consenting eligible adults with small, low risk PTC (< 2cm in maximal diameter, confined to the thyroid, and not immediately adjacent to critical structures in the neck) are offered the choice of AS or surgery for management of PTC. Patient participants are free to choose either option (AS or surgery) and the disease management course is thus not assigned by the investigators. Surgery is provided as usual care by a surgeon in an institution of the patient's choice. Our primary objective is to determine the rate of 'failure' of disease management in respective AS and surgical arms as defined by: i) AS arm - surgery for progression of PTC, and ii) surgical arm - surgery or other treatment for disease persistence or progression after completing initial treatment. Secondary outcomes include long-term thyroid oncologic and treatment outcomes, as well as patient-reported outcomes. DISCUSSION: The results from this study will provide long-term clinical and patient reported outcome evidence regarding active surveillance or immediate surgery for management of small, low risk PTC. This will inform future clinical trials in disease management of small, low risk papillary thyroid cancer. REGISTRATION DETAILS: This prospective observational cohort study is registered on clinicaltrials.gov (NCT04624477), but it should not be considered a clinical trial as there is no assigned intervention and patients are free to choose either AS or surgery.

Active surveillance (AS) in the management of small, low risk papillary thyroid cancer (PTC) as an alternative option to thyroidectomy, is an area of active research. A national Canadian study is proposed to evaluate the long-term outcomes of patients with small, low risk PTC who choose AS or surgery. This letter describes the proceedings of a national investigator meeting to plan the study.

The Navy Clothing and Textile Research Facility (NCTRF) designed and fabricated a thermal energy test apparatus to permit evaluation of the heat protection provided by crash crew firefighter's proximity clothing materials against radiant and convective heat loads, similar to those found outside the flame zone of aircraft fuel fires. The apparatus employs electrically operated quartz lamp radiant heaters and a hot air convective heater assembly to produce the heat load conditions the materials are to be subjected to, and is equipped with heat flux sensors of different sensitivities to measure the incident heat flux on the sample material as well as the heat flux transmitted by the sample. Tests of the apparatus have shown that it can produce radiant heat flux levels equivalent to those estimated to be possible in close proximity to large aircraft fuel fires, and can produce convective heat fluxes equivalent to those measured in close proximity to aircraft fuel fires at upwind and sidewind locations. Work was performed in 1974.