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Both of the incidences of thyroid nodules and thyroid cancer have increased in recent years, which have attracted extensive attention. Surgical treatment plays an important role on the management of thyroid nodules and differentiated thyroid cancer (DTC). Usually patients will have an excellent prognosis after standard surgery, in the meantime, they will suffer from wrongly performed operation, which induces bad outcomes for the patients and their families both physically and psychologically, as well as economic burden. There are many guidelines concerning the suitable treatment for thyroid nodules and thyroid cancer all over the world, and the most famous one is American Thyroid Association (ATA) Management Guidelines for Patients with Thyroid Nodules and DTC in 1996 and the revised version in 2009. Over the past several years, there have been many advances in both the diagnosis and treatment of thyroid nodules and DTC. As a result, the ATA had updated the guidelines in 2015. In this article, we introduced the surgical update in 2015 ATA management guidelines for adult patients with thyroid nodules and DTC compared to the 2009 version, which consists of appropriate operation for thyroid nodules and DTC, operation for pregnant women with DTC, lymph node dissection, completion thyroidectomy, appropriate perioperative approach to voice and parathyroid, and surgery for advanced cancer.