Multiple prognostic factors for outcome in papillary thyroid carcinoma are identified. For a cohort of 1500 consecutive patients followed an average of 16 years, survival rates for tumor recurrence and cause-specific mortality are described. Risk groups derived from novel prognostic scoring or staging systems and the role of DNA ploidy testing are discussed specifically. Lastly, controversies are reviewed regarding the extent of primary surgical resection and the efficacy of postoperative radioiodine remnant ablation in papillary thyroid cancer.