Thermal ablation has emerged as a new treatment option for papillary thyroid microcarcinoma (PTMC). The present review aimed to describe the efficacy and safety of microwave ablation (MWA) on low risk PTMC, as a minimally invasive treatment avoiding overtreatment with surgery and risk of tumor progression under active surveillance. In this review, the efficacy and safety of MWA on benign and malignant nodules were summarized. We compared MWA with laser ablation, radiofrequency ablation and surgery. The optimal follow-up strategies, including postoperative surveillance of ablated tumor lesion, evaluation of lymph node metastasis, were also addressed. In conclusion, MWA is effective and safe for low-risk PTMC, but possible risks should be carefully evaluated before and after its implementation.