Advanced thyroid cancer is often encountered by otolaryngologists specializing in head and neck surgery and endocrine surgery as well as by comprehensive otolaryngologists in the private practice setting. Management of patients with advanced thyroid cancer can be challenging and there have been substantial changes in the available treatment options in recent years. The first goal of this session is to define advanced thyroid cancer. The second goal is to discuss the preoperative evaluation of advanced thyroid cancer including the role of diagnostic imaging and molecular testing. The specific mutations that can be identified in thyroid cancer and the targeted and non-targeted treatment options that are available depending on the results of molecular testing will be reviewed. Finally, the session will cover aspects of surgical decision making and the role of pre- and postoperative adjuvant therapy. The session will use case presentations to illustrate state-of-the-art management of patients with advanced thyroid cancer.