AbstractBackgroundAdvanced thyroid disease involving the mediastinum may be managed surgically with a combined transcervical and transthoracic approach. Contemporary analysis of this infrequently encountered cohort will aid the multidisciplinary team in personalizing treatment approaches.MethodsRetrospective review of patients undergoing combined transcervical and transthoracic surgery for thyroid cancer at a single high‐volume institution from 1994 to 2015.ResultsThirty‐eight patients with median age 59 years (range 28–76) underwent surgery without perioperative mortality. Most patients had primary disease. A majority had distant metastases outside the mediastinum but had locoregionally curable disease. Common complications were temporary (39%) and permanent (18%) hypoparathyroidism, and wound infection (13%). One‐year overall survival was 84%; 1‐year locoregional disease‐free survival was 64%. Median time to locoregional recurrence was 36 months. Only esophageal invasion was associated with worse oncologic outcomes.ConclusionsCombined transcervical and transthoracic surgery for advanced thyroid cancer can be performed without mortality and with acceptable morbidity.