A total of 704 cases of thyroid cancer were retrospectively reviewed (2005 to 2011) to assess the contribution of frozen section (FS) to preoperative fine-needle aspiration (FNA). There were 613 papillary carcinomas (87.1%), of which 237 were <1.0 cm. FNA was diagnostic or suspicious in 39.9% of micropapillary thyroid carcinomas and 75.8% of papillary carcinomas. FS was diagnostic in 52.3% and 76.6%, respectively. In no instance did the FS diagnosis change the procedure (total or near-total thyroidectomy). Neither FNA nor FS was diagnostically definitive in follicular neoplasms. A diagnosis of follicular carcinoma was made only after thorough histologic analysis. FS should have a less prominent role in the management of thyroid masses, especially in the context of total thyroidectomy for benign disease. FS may be more productively applied to the identification of metastatic lymph nodes or parathyroids in the surgical field.