The management of thyroid carcinoma continues to evolve. Several aspects of the surgical management of patients with thyroid carcinoma remain controversial and include attempts to optimize an adequate oncologic resection while reducing patient morbidity. Surgical areas of particular interest that are explored in this chapter include the indications and utility of thyroid lobectomy for patients with differentiated thyroid carcinoma. In addition, surgical management of the regional lymph nodes is discussed, with the role of prophylactic central neck dissection in the setting of no survival advantage and the approach to the lateral neck lymph nodes in patients with differentiated thyroid carcinoma. Finally, aspects that have drawn increased interest like active surveillance of microcarcinomas to surgical treatment of recurrent thyroid carcinomas are further discussed. The chapter aims to increase understanding of the surgical aspects that remain controversial and promote further study into these various topics.