Thyroid cancer is a common head and neck cancer in the world, and most patients with thyroid cancer have a good prognosis. The main cause of death from thyroid cancer was mainly due to infiltration of vital organs of the neck in advancedstage or extensive metastasis. Highly differentiated thyroid cancer is different from other advanced malignant tumors, which develops slowly with “bioinert” characteristics. If appropriate treatment is adopted, it can prolong the life of patients and maintain their quality of life. At present, domestic and international treatment of locally advanced differentiated thyroid cancer is mainly based on surgery. Postoperative adjuvant therapy with radioactive iodine and TSH inhibition therapy have been reached a consensus, but the treatment of tumor invasion of the recurrent laryngeal nerve and trachea is still controversial. This article discusses the surgical approach and controversy of locally advanced, highly differentiated thyroid cancer with invasion of the larynx, trachea, esophagus, and large vessels of the neck. At the same time, the future treatment of advanced highly differentiated thyroid cancer is described, including the latest progress of neoadjuvant therapy, artificial tracheal, the targeted therapy, and the application of multipl disciplinary team diagnosis and treatment model. Meanwhile , the remaining problems are discussed.