Differentiated thyroid carcinoma （DTC） is generally associated with an excellent prognosis. However, patients with invasion of the surrounding organs, including the upper aerodigestive tract, or certain aggressive microscopic variants are known to have a relatively poor prognosis and quality of life. Kinase inhibitor therapy was approved for patients with radioactive iodine-refractory DTC with metastatic, rapidly progressive, symptomatic disease and/or unresectable locally advanced recurrent disease. However, almost no studies have been conducted on whether locally advanced recurrent tumors are surgically resectable. Locally advanced recurrent tumors may invade great vessels （such as the carotid and vertebral arteries）, the parapharyngeal space, or the mediastinum, making surgical treatment challenging. Many patients with locally advanced recurrent tumors have concurrent distant metastases. Surgical decision-making in these patients must consider the prospects of complete resection, functional prognosis, and life expectancy. In our own experience, good local control can be achieved in patients with locally advanced recurrent disease that undergo complete resection. However, several mortalities were attributed to distant metastasis. Therefore, the optimal treatment for these tumors is complete surgical resection. The indications for surgery for locally advanced recurrent tumors should be investigated and discussed.