Surgery is the primary therapy for patients with papillary thyroid cancer, and it should be performed by a surgeon with expertise in thyroid surgery. The optimal extent of the thyroidectomy is controversial. For single small tumors (<1.5 cm), most studies do not demonstrate better survival rates after a total thyroidectomy compared with a lobectomy plus an isthmusectomy.[9] However, in many studies, recurrence rates appear to be higher after a lobectomy vs a total thyroidectomy, even after adjustment for extent of disease.[9] A total thyroidectomy also has the theoretical advantage of permitting total-body radioiodine scanning following surgery to screen for local or distant metastatic spread; also, serum Tg levels will be lower after a total thyroidectomy, allowing this tumor marker to be used more specifically in follow-up. However, the complication rates of a total thyroidectomy are higher, including hypoparathyroidism and injury to the recurrent laryngeal nerves, than after unilateral procedures. This underscores the importance of having surgeons with special expertise perform such operations. A total or near-total thyroidectomy is clearly indicated, when feasible, in patients with locally invasive or distant metastatic disease, as well as in patients with papillary cancer who have a history of head and neck irradiation. A modified radical neck dissection is usually indicated for patients with clinically palpable extensive ipsilateral cervical adenopathy. Radical neck surgery is rarely, if ever, indicated in patients with uncomplicated papillary cancer, but may be indicated when there is locally invasive disease.