BACKGROUND: Surgical resection is the key to management of thyroid cancer, but determining the optimal surgical procedure for individual cases has been controversial. METHODS: The author reviews several large data bases that allow examination of prognostic criteria for long-term outcomes. RESULTS: Patients can be classified into good- or poor-risk groups that assist defining the optimal surgical procedure. Routine use of total thyroidectomy in all patients with thyroid cancer is best avoided; however, patients with medullary cancer generally need total thyroidectomy. CONCLUSIONS: The definition of risk groups has clarified the options regarding choice of primary surgical therapy for differentiated thyroid cancer.
