Follicular thyroid cancer is the second most common thyroid malignancy. Dietary iodine content may determine the relative proportion of follicular thyroid cancer and papillary thyroid cancer. Several subgroups of follicular thyroid cancer, which may show some differences in clinical behavior, can be recognized histologically. Primary treatment of follicular thyroid cancer is complete surgical removal of tumor, usually followed by suppressive thyroid hormone therapy. High-risk patients may also undergo radioiodine remnant ablation. The prognosis for young patients with small, minimally invasive tumors is excellent, whereas older patients with more extensive tumors or distant metastases at presentation may suffer substantial morbidity and mortality. Follow-up should be most intense during the first 5 years after the initial surgery and involves serum thyroglobulin measurements and, for some patients, diagnostic radioiodine scanning.