The treatment of Hürthle cell neoplasms of the thyroid is controversial because of a lack of information about their clinical behavior and long-term follow-up. We reevaluated our experience of the past 33 years and compared our early experience with the more aggressive surgical approach used during the past ten years. We treated 62 patients with Hürthle cell neoplasm from 1949 through 1982. Twenty-six patients had benign neoplasms and 35 had malignant neoplasms proven by capsular or vascular invasion or nodal metastasis. Fourteen deaths were directly attributable to recurrent or metastatic disease, three among those with benign lesions. An aggressive surgical approach, involving total thyroidectomy or early-completion total thyroidectomy following lobectomy for all tumors histologically malignant or larger than 2 cm, resulted in a lower recurrence rate (21% v 59%) and fewer operations per patient (1.7 v 2.9) than in patients having other operations.