Reoperative surgery in the neck for recurrent/persistent well-differentiated thyroid cancer is associated with increased morbidity compared with primary surgery. Reoperative surgery is technically more challenging because of the presence of scar tissue and disruption of the normal fascial planes and anatomy, which may result in a greater risk of injury to nerves and other vital structures. When performing reoperative surgery, an algorithm should be followed that allows for safe and effective removal of recurrent/persistent disease. This algorithm should include a systematic review of prior operative and pathology notes, imaging studies appropriate for localization of disease, an understanding of reoperative central and lateral neck anatomy, along with an appreciation for disease behavior.