Thyroid cancer is the most common malignant tumor of the endocrine system, and its incidence has been increasing worldwide in recent years, especially in papillary microcarcinoma; in the Asia-Pacific region, thyroid cancer has been listed as one of the top ten most common tumors in women. The main controversies in the treatment of thyroid cancer are the scope of primary lesion treatment and the indications for cervical lymph node dissection. The scope of primary lesion management: European, American and some domestic scholars advocate that total thyroidectomy or subtotal thyroidectomy should be performed for most differentiated thyroid cancers; lobectomy can be considered for single thyroid nodules with undiagnosed biopsy results or malignant lesions with small, low-risk, solitary, intraperitoneal papillary carcinoma and no cervical lymph node metastasis. Since total thyroidectomy may cause more serious postoperative complications: (1) serious hypocalcemia due to parathyroid gland miscutting or inadequate blood supply; (2) bilateral exposure of the recurrent laryngeal nerve, the probability of injury increases significantly. At present, most oncology hospitals in China advocate resection of the affected lobe + isthmus, based on the following theories: (1) the true clinically significant recurrence in the residual thyroid gland is much lower than that of microscopic cancer detected by pathology. ②The probability of differentiated thyroid cancer transforming into poorly differentiated or undifferentiated carcinoma is extremely low. ③If a tumor develops in the contralateral thyroid gland during the follow-up period, reoperation with a lateral entry surgical route does not increase the difficulty of surgery or postoperative complications. (iv) The long-term quality of survival was better in patients who underwent lobectomy and isthmus than in those who underwent total thyroidectomy, and there was no statistically significant difference in the 10-year survival rate after surgery. The key to the affected lobe + isthmus resection is to fully evaluate the healthy lobe for suspicious malignant lesions before surgery; if the nodes in the healthy lobe are routinely explored intraoperatively, and if intraoperative freezing is malignant or suspicious, total thyroidectomy should be performed instead to ensure surgical completeness. Indications for cervical lymph node dissection: Lymph node metastasis in the lateral cervical region (cN1b+): functional or radical cervical lymph node dissection has become the clinical consensus. Since differentiated thyroid cancer has a better prognosis and metastatic lymph nodes are mostly free of extraperitoneal invasion; and patients are mostly middle-aged and young, with higher requirements for function and appearance, elective cervical lymph node dissection with preservation of the cervical plexus is being gradually applied. Combined with domestic and international studies, the recommended indications for surgery are: N1b+ differentiated thyroid cancer (except metastasis in area VA) with small metastatic lymph nodes (≤3 cm in diameter) and no extraperitoneal invasion. Contraindications for surgery are: (1) those who have a history of irregular cervical lymph node dissection or deep sternocleidomastoid lymph node biopsy before surgery; (2) those who have extensive cervical lymph node metastasis or obvious lymph node invasion. Negative cervical lymph nodes (cN0): Whether patients undergo selective cervical lymph node dissection, foreign scholars have tended to agree that patients with cN0 may not undergo cervical lymph node dissection. Selective cervical lymph node dissection in cN0 patients does not improve the prognosis, but obviously affects the patient’s appearance and quality of life, and if cervical lymph node metastasis occurs during long-term follow-up, further dissection does not affect the prognosis. In follicular carcinoma, the metastasis is mainly hematologic, so cN0 patients should not be cleared in the lateral cervical region or in the central region; in medullary carcinoma, due to the obvious tendency of lymphatic metastasis and the tendency of metastasis to the anterior superior mediastinum, cN0 patients can be considered for selective clearance of the lateral cervical region, while the central region should be routinely cleared and the lymphatic clearance of the anterior superior mediastinum should be emphasized. The need for prophylactic lateral cervical dissection based on the number or proportion of lymph node metastases in the central region has been suggested, but there is a lack of evidence-based medical data to support this. Central zone lymph node negativity (cN0): There is a consensus that preoperative evaluation and intraoperative exploration should routinely perform central zone lymph node dissection considering central zone lymph node metastases. However, it should be noted that thyroid cancer has the highest probability of metastasis to the central region among the seven divisions of the neck; and patients with negative preoperative ultrasound or CT evaluation still have a high rate of lymphatic metastasis after routine debulking. Most oncology hospitals advocate that the lymph nodes in the central region (mainly including paraglottic nerve, pre-tracheal, and paratracheoesophageal lymph nodes) should be cleared at the same time when dealing with the primary focus, which does not significantly increase the operation time under the skilled operation of doctors with specialized training, can reduce the inadvertent injury to the paraglottic nerve and parathyroid glands due to scarring during reoperation, reduce the probability of lymph node metastasis in the lateral cervical region, and is conducive to the accurate clinical staging and judgment of tumor It can also reduce the probability of lymph node metastasis in the lateral cervical region, which is beneficial to the accurate clinical staging and prognosis of the tumor [12]. For patients with lymph node metastasis in the unilateral central region, the establishment of a prediction model of whether the contralateral central region clearance needs to be performed at the same time is a direction for future research. Due to the differences in the level of understanding and treatment of thyroid diseases in different hospitals in China, the level of preoperative ultrasound, puncture cytology diagnosis and intraoperative frozen pathology also needs to be further improved, and the standardization of thyroid disease treatment and specialized training in thyroid surgery should be strengthened to provide more reasonable and effective treatment to patients.