Thyroid cancer has risen from the top 10 malignancies in women in late 2000 to fifth in 2010, with PTMC incidence increasing rapidly and will continue to increase with the use of high-resolution ultrasound and widespread screening. The prevalence of nail cancer is not created by ultrasound, but there is a controversy about whether ultrasound is overdiagnostic. Although PTMC is suspected to be overdiagnosed, it is also controversial whether overdiagnosis will lead to overtreatment; PTMC is limited to tumor diameter ≤1cm, but TNM staging is not necessarily T1aN0M0. For PTMC, the mindset of deciding treatment based on tumor size alone must be changed and handled with caution. The core issue in the treatment of PTMC is how to perform accurate risk stratification before and after surgery, and the determination of the scope of surgery, postoperative RAI treatment, and the target of TSH suppression treatment, all of which require accurate risk stratification as a guide. Currently, preoperative risk stratification relies mainly on ultrasound and FNA, with an accuracy rate of about 90% even in skilled hospitals, and the risk stratification in the guidelines is basically pathological, which is of little value for preoperative decision making. Today, total thyroidectomy + zone VI (central zone) clearance is the mainstay of DTC (T1-2, cN0-1a) internationally, and lobectomy is less common. 2012 domestic guidelines stipulate that unilateral DTC surgery should follow the principle of “two minimums”: at least lobectomy + isthmus and at least lymph node clearance in the central zone. Radiofrequency ablation (RFA), as a new minimally invasive method, has been proven to be safe and effective in the treatment of some thyroid nodules, and has been developing rapidly in the domestic medical market in recent years. However, accordingly, the phenomenon of blindly expanding the indications for ablation, intentionally exaggerating or even deceptively promoting the ablation effect, and the high economic cost of repeated ablation have become more and more prominent. By reviewing the latest domestic and international literature, combining clinical observation of patients after ablation, and understanding and analyzing the current domestic and international ablation guidelines, it is concluded that the diagnostic level of preoperative examinations such as thyroid ultrasound and FNA in different hospitals in China is uneven and imperfect, the indications for RFA are not strictly grasped, and there is a lack of prospective, randomized multicenter, large sample of evidence comparing the efficacy of RFA with surgery and other non-surgical treatment options. There is a lack of prospective, randomized, multicenter, large sample of evidence-based medical evidence to compare the efficacy of RFA with surgery and other non-surgical treatment options. Therefore, the routine use of RFA for benign thyroid nodules is not recommended at this stage, and its use for the initial treatment of differentiated thyroid cancer is strongly discouraged. In general, the predominance of surgery has never wavered in its treatment status. Based on the current lag in postoperative risk stratification, preoperative FNA, intraoperative molecular diagnostic techniques for lymph nodes in the VI region, and timely analysis of rapid frozen pathology (IOFSB) should be given attention and studied in this regard. If postoperative pathology shows more than 5 metastatic lymph nodes in the central region with a diameter of more than 3 mm, then the residual thyroid should be resected following the guidelines. In patients with PTMC that can be dynamically observed, caution should be exercised in either management.