Most patients with thyroid cancer (of follicular cell origin) are successfully managed with a combination of surgery, radioactive iodine (₁₃₁I-RAI), and suppression of thyroid-stimulating hormone with thyroid hormone replacement, obtaining survival rates approaching 90% at 20 years. Although the prognosis of patients with differentiated thyroid carcinoma (DTC) is favorable, recurrence occurs in up to 30% patients. In addition, many patients with recurrent or metastatic disease, as well as those with less differentiated tumors, will have a much poorer prognosis and lose their ability to concentrate functional iodine and are therefore not targeted by ₁₃₁I-RAI therapy. There are many treatment options but no definitive treatment for radioiodine refractory thyroid cancer. This paper will discuss the roles of surgical treatment for patients with radioiodine refractory thyroid cancer.