AbstractOccult and microscopic differentiated carcinoma of the thyroid is a clinically benign lesion, even when accompanied by lymph node metastases, and should be treated surgically by conservative procedures. Clinically detectable thyroid carcinomas may be of low‐risk types in younger patients or high‐risk types in older patients. Age is the primary determinant of risk. Low‐risk patients should be treated conservatively since the risk of death is currently no higher than 1.5%. High‐risk patients should be treated more aggressively since recurrence rates may be high and risk of death from disease may reach 15% to 20%. In all patients, total thyroidectomy should be avoided since it does not improve local control rates or cure rates and exposes the patient to considerable risk of iatrogenic hypoparathyroidism and recurrent nerve injury. This recommendation is particularly true for occult and microscopic disease as well as for low‐risk disease, because risk of death from disease is so low.