In Europe, the United States, Japan and other countries, patients with papillary thyroid cancer without peri-jugular lymph node metastasis are recommended to undergo total bilateral thyroidectomy + central group lymph node dissection (central group lymph nodes include bilateral tracheoesophageal groove lymph nodes and pre-tracheal lymph nodes). Postoperative isotope (iodine 131) therapy is performed. The advantage of this procedure is that the central group lymph nodes, which are prone to metastasis (the metastasis rate of the central group lymph nodes is reported to be as high as 50% in the literature, and it is difficult to detect the metastasis of the central group lymph nodes by preoperative ultrasound because of their proximity to the trachea), and the possible residual cancer cells can be destroyed by isotope treatment after removal of the bilateral thyroid gland, which improves the therapeutic effect of thyroid cancer surgery. The treatment effect of thyroid cancer surgery can be improved by isotope therapy after removal of both thyroid glands to eliminate possible residual cancer cells and to determine whether the tumor has recurred or metastasized by testing thyroglobulin (Tg) levels and doing isotope scans after surgery. In addition, studies have found that this procedure has the advantage of improving long-term (20 or even 30 years) survival rates. In China, the understanding of total bilateral thyroidectomy + central group lymph node dissection is different from that in foreign countries, and therefore, the surgical approach varies widely. Here, I will only discuss my views on the scope of surgery for papillary thyroid cancer without peri-jugular lymph node metastasis. For patients with nodules in only one side of bilateral thyroid: 1. If this nodule is confirmed to be papillary carcinoma during surgery, whether it is microscopic or not, I think it is best to perform total excision of the thyroid gland on that side + clearance of the central group of lymph nodes (tracheoesophageal groove lymph nodes and pre-tracheal lymph nodes) on that side. This is especially true for patients older than 45 years of age. The special emphasis here is on papillary microscopic carcinoma, which also has a relatively high rate of lymph node metastasis; therefore, it is recommended that lymph node dissection is preferable. 2. If no metastasis is found as a result of lymph node dissection, it is not necessary to remove the other side of the thyroid gland because there are no nodes on the other side of the thyroid gland. Postoperatively, thyroxine tablet preparation is taken to inhibit the development of the disease. If the ultrasound reveals suspicious nodules on the opposite side of the thyroid gland, then the thyroidectomy on the opposite side will be considered. 3. If lymph node dissection reveals metastasis, it is best to remove the contralateral thyroid gland together. Post-operative isotope therapy will be done to consolidate the treatment effect. If one side of the thyroid gland is confirmed to be papillary carcinoma and the other side has nodules, there is a 20% to 40% chance that these nodules will develop into malignant nodules, therefore, I think it is better to perform total excision of both thyroid glands and clearance of the central group (tracheoesophageal lymph nodes + pre-tracheal lymph nodes) on the cancerous side. If no metastasis is found in the lymph nodes, postoperative isotope therapy is not necessary and thyroxine preparations can be taken. If lymph node metastasis is present, postoperative isotope therapy can be considered. For those who have bilateral thyroid nodules and are found to have bilateral papillary thyroid carcinoma by intraoperative pathology: I think it is best to perform total excision of both thyroid glands and clearance of bilateral central groups (tracheoesophageal sulcus lymph nodes + pre-tracheal lymph nodes). Postoperative isotope therapy can be considered.