Clinicians must make thoughtful decisions regarding patients presenting with thyroid nodules and fine-needle aspiration biopsy aspirates containing oncocytic (Hurthle) cells. It is well known that surgery is an important line for managing thyroid pathologies. For oncocytic/Hurthle cell lesions, however, prudency of surgical decision, appropriateness of surgery extent, and postoperative management are debatable. This chapter discusses the controversies related to management of patients with oncocytic/Hurthle cell neoplasms; whether to operate or not to operate, whether to perform hemithyroidectomy or total thyroidectomy in case surgery is indicated, and whether or not to use postoperative radioactive iodine or external beam radiation therapy.