Differentiated thyroid carcinoma (DTC) constitutes > 90% of all thyroid cancers and is generally associated with a very good prognosis due to effective surgery and adjuvant therapies. The overall survival (OS) rate at 10 years is reported to be 80 to 94%. Despite an excellent prognosis, locoregional recurrences are common and warrant lifelong follow up. Locoregional recurrence is a significant cause of morbidity among DTC patients. Various studies have reported that mortality in DTC patients is directly related to loco-regional recurrence. Optimal treatment for the management of recurrent/persistent lymph nodes in DTC is still debatable, especially for low volume disease. Modalities available for treatment are either surgery/and RAI or observation. Local ablative therapies like alcohol ablation and radiofrequency ablation are also being used by various groups. The contentious issue is recurrences of less than one centimeter. Follow up with Tg/ATg and USG neck is a reasonable alternative to surgery as finding subcentimetric lymph node in scarred tissue is particularly difficult even in expert hands.