Anaplastic thyroid carcinoma is one of the most aggressive malignancies, with a poor prognosis. Although rare, representing only 2% of clinically recognized thyroid cancers, the overall median survival is limited to months. Most patients are elderly and seek treatment with a rapidly growing mass. Almost half the patients seek treatment with distant metastases, with as many as 75% developing distant disease during their illness. In most the patients, complete surgical resection is not possible. There are, however, a few patients with resectable disease reported in the literature who have demonstrated long-term survival with aggressive multimodal therapy that included surgery, radiation, and chemotherapy. Preclinical studies in human anaplastic thyroid carcinoma cell lines show promise that new approaches to the management of this disease will be found in the future. Until such time when an effective regimen is found, all patients with anaplastic thyroid carcinoma should be evaluated for multimodal therapy in the setting of a clinical trial.