In this study the authors analyze the indications and the type of surgical procedure to perform on the neck lymph nodes in cases of differentiated thyroid carcinoma.The study has been carried in a retrospective way. Between 1993 and 2001, 93 differentiated thyroid cancer were observed. There were 72 women and 21 men, with a mean age of 45.9 years (range 18-77). Patients have been divided into three groups: the first included 25 patients who underwent only thyroidectomy (24 total thyroidectomy, 1 lobectomy); the second group included 52 patients who underwent total thyroidectomy and lymphadenectomy of the central compartment. The third group included 16 patients who underwent total thyroidectomy and functional neck dissection. The median follow-up was 65.9 months.The postoperative complications was similar between three groups. Follow-up has shown similar survival and recurrences between groups.The elective lymphadenectomy of the central could be a solution for a routine treatment of differentiated thyroid cancer without lymph node involvement. The presence of cervico-lateral node metastases imposes a functional neck dissection.