The incidence of thyroid cancer has risen sharply in recent decades. While most thyroid cancers are low-risk and have an excellent prognosis, a minority of patients develop advanced-stage disease with increased morbidity and mortality. An individualized approach is essential to optimize oncological outcomes while minimizing treatment-related complications. Molecular biology plays a growing role in the preoperative assessment of malignancy risk. Therapeutic de-escalation has been underway for a decade with active surveillance of thyroid cancer <10 mm, a decrease in the extent of initial surgery, and a decrease in postoperative radioactive iodine administration. Close collaboration between endocrinologists, pathologists, nuclear medicine physicians, radiologists, and surgeons remains critical to diagnosis and management.