The incidence of thyroid cancer has almost quadrupled over the past 30 years in the United States, a large number of which are less than 2 cm in size. There have been several paradigms in the management of well-differentiated thyroid cancer. The common debate in the past was total vs less than total thyroidectomy, however recently there is more interest in evaluation of fine needle aspiration of thyroid nodules, and intraoperative management in relation to the central compartment. The debate about elective central compartment nodal dissection vs observation has generated considerable controversy in the recent literature. Postoperative follow-up with thyroglobulin and ultrasound has become the mainstay of postoperative evaluation. Radioactive iodine ablation has been used in selected patients with advanced or aggressive thyroid cancer. While risk stratification continues to be an important facet in the evaluation of thyroid cancer, low risk patients are rarely offered radioactive iodine ablation. Understanding of the details of the histopathology is crucial, especially dividing the patients between well-differentiated and poorly differentiated thyroid cancer. PET scanning has been useful in the follow-up of patients with poorly differentiated, insular or tall cell thyroid cancer. External radiation therapy is used in selected patients where gross residual disease was present or there are painful bony metastases. Considerable research has been undertaken to identify specific molecular markers and their applicability for targeted therapy. This manuscript describes the current debates and shifting paradigms in the management of well-differentiated thyroid cancer.