Objective: To evaluate the feasibility and clinical value of endoscopic thyroidectomy for early-stage differentiated thyroid carcinoma (DTC). Methods: The clinical data of 75 patients with early-stage DTC treated between January 2010 and June 2013 were retrospectively analyzed. Of the patients, 15 cases received totally endoscopic thyroidectomy (endoscopic operation group) and 60 cases were subjected to traditional open surgery (traditional operation group). All patents underwent at least resection of the affected lobe and isthmus plus central compartment neck dissection. The main clinical variables and postoperative cosmetic results between the two groups were compared. Results: Totally endoscopic thyroidectomy was successfully completed in all of the 15 patients without open conversion or postoperative massive hemorrhage. The operative time in endoscopic operation group was somewhat longer than that in traditional operation group, but the difference did not reach a statistical significance (P=0.059); there were no cases of postoperative hypocalcemia or hoarseness in any of the groups, and the clinical variables that included intraoperative blood loss, postoperative drainage volume, length of hospital stay and number of resected lymph nodes from the central compartment between the two groups showed no statistical difference (all P>0.05). Patients in the two groups were followed up for 6 to 36 months; no recurrence was noted, and the scars in patients of endoscopic operation group were small and not conspicuous, which yielded obviously better cosmetic results compared with traditional operation group. Conclusion: Totally endoscopic thyroidectomy for early-stage DTC is safe and feasible, with excellent cosmetic effect.