Thyroid cancer is estimated to comprise approximately 1% of all new malignancies diagnosed annually in Europe; 3 out of 100,000 people develop a thyroid malignancy. Due to the different biological behavior of papillary (PTC), follicular (FTC), medullary (MTC), and undifferentiated thyroid carcinoma (UTC), a different surgical therapy is required not only according to tumor stage but also to carcinoma type. Regarding the results reported by other authors as well as our own, we recommend the following strategy as primary surgery in thyroid carcinoma: Total thyroidectomy should be performed in all patients. The only indication for less than total thyroidectomy is a papillary thyroid carcinoma ( < l cm diameter), classified as unifocal pTINOMO carcinoma. The indications for completion thyroidectomy are an incomplete tumor resection at initial treatment, a pT category higher than pTl, multifocal intraglandular tumor invasion, and proven or suspicious lymph node metastases. Systematic lymphadenectomy of the cervicocentral compartment (Cl) should be performed generally. In case of proven or suspicious tumor-involved lymph nodes of the lateral compartments (C2/C3) in patients with papillary thyroid carcinoma, systematic lymphadenectomy should also be performed. Patients with medullary thyroid carcinoma should undergo systematic lymphadenectomy of both cervicolateral compartments (C2/C3) and of the mediastinal compartment (C4) in case of tumor involvement of the central compartment (C1). In case of extrathyroidal tumor extension, radical resection of all tumor-involved structures should be performed whenever possible, because only total resection of the tumor enables the chance of cure. In cases of life-threatening cervicovisceral obstruction, surgery may be indicated even in case of concomitant distant metastases. New techniques of tracheal and esophageal reconstruction are available today to restore airway and esophageal passage.