Local recurrencies, in patients with previous thyroidectomy and 131I ablative therapy for differentiated thyroid cancer, indicate disease progression in the thyroid bed and in the regional lymph nodes. They appear in 5% to 20% of patients. The efficacy of radioiodine therapy is conditioned essentially by the size, the radioiodine uptake and the radiation dose absorbed by residual or recurrent thyroid tissue. For macroscopic tumor deposits and absorbed radiation doses below 3500 cGy, the therapeutic response is poor. Therefore surgery represents the main form of treatment. Surgery should be performed at a single session, thereby precluding the need for subsequent surgical procedures. To avoid these difficulties we used the advantages of high radioiodine activity and a gamma probe to perform the radical surgery in a single session. Day 0. Patient receives 3.7 GB of 131I in hypothyroid condition. Day 3. Patient is discharged from the isolated room and a pre-surgery whole-body-scanning with a neck spot view is performed. Day 5. Surgery is performed using gamma-probe. After the nodes are removed, radioactivity is measured in the lesion bed to confirm the success of the dissection. Day 7. Postoperative neck scan is performed using the remaining radioactivity to evaluate the success of the surgery.