Although thyroid nodules occur quite frequently, thyroid carcinoma is a relatively infrequent malignancy. Fine needle aspiration has proven to be the most efficient, most accurate diagnostic procedure in the management of nodular thyroid disease, and it has significantly improved the selection of patients for surgery. Although there is still some controversy, most authors advocate total thyroidectomy for differentiated thyroid carcinoma. This treatment strategy facilitates detection of recurrence with 131I and allows for more effective treatment of recurrent disease. Several novel prognostic markers are being investigated to help identify the most aggressive thyroid malignancies and thus aid in the overall treatment of patients with these tumors.