Thyroid surgery has transitioned from the high-morbidity era of Billroth to a modern discipline defined by subspecialist precision. This presentation reviews the historical foundations laid by Theodor Kocher—whose meticulous technique earned the 1909 Nobel Prize—and William Halsted, whose emphasis on delicate tissue handling and haemostasis remains the cornerstone of the Australian open approach. This is contrasted against the rising popularity of minimally invasive, or robotic approaches to thyroid surgery. In terms of modern updates in the management of multinodular goitres (MNG) and malignancies, the emphasis remains on the impact of surgeon volume on complication rates, specifically permanent hypoparathyroidism and recurrent laryngeal nerve (RLN) palsy. While the standard open thyroidectomy remains the gold standard in Australia, the integration of surgical adjuncts is interrogated and the utility of intraoperative neuromonitoring and near-infrared fluorescence for parathyroid identification are discussed as essential tools for risk mitigation. Regarding malignancy, we examine the shift toward risk-stratified care. This includes the nuanced role of molecular testing in indeterminate cytology and the 2025 updates on central and lateral neck dissection. The morbidity of prophylactic versus therapeutic clearance in the N0 neck is discussed, providing a contemporary framework for the ENT/Endocrine surgeon to optimize oncological and functional outcomes [1]. [1] Ringel, M. D., Sosa, J. A., Baloch, Z., Bischoff, L., Bloom, G., Brent, G. A., Brock, P. L., Chou, R., Flavell, R. R., Goldner, W., Grubbs, E. G., Haymart, M., Larson, S. M., Leung, A. M., Osborne, J., Ridge, J. A., Robinson, B., Steward, D. L., Tufano, R. P., & Wirth, L. J. (2025). 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid : official journal of the American Thyroid Association, 35(8), 841–985. https://doi.org/10.1177/10507256251363120