Objective To summarize advances in research on papillary thyroid carcinoma of the isthmus (PTCI) and provide a basis for further optimizing its diagnostic and therapeutic strategies. MethodsRelevant literatures on PTCI published in recent years were searched and reviewed, focusing on its clinicopathological characteristics, molecular biological features, patterns of lymph node metastasis, high-risk factors, and treatment strategies. ResultsPTCI has distinct anatomical and clinicopathological characteristics. Some studies reported that it has higher risks of capsular invasion, extrathyroidal extension, and central lymph node metastasis. However, whether PTCI is more aggressive than lobar papillary thyroid carcinoma remains controversial. Tumor size, capsular invasion, extrathyroidal extension, and multifocality may be associated with lymph node metastasis. Different surgical approaches may be appropriate for selected patients, and the extent of surgery should be individualized according to tumor characteristics and the risk of lymph node metastasis. ConclusionsPTCI differs from lobar papillary thyroid carcinoma in clinicopathological characteristics and surgical strategies. Treatment decisions should be individualized based on tumor burden, local invasion, and the risk of lymph node metastasis, rather than extending the surgical extent solely because of the isthmic location of the tumor.