Genomic sequencing is the fundamental approach for achieving precision medicine in cancer treatment. It assists in tumor diagnosis, prognosis assessment, and guidance for targeted drug therapy. In recent years, genomic sequencing technology has been widely applied in the clinical diagnosis and treatment of thyroid cancer. However, as of now, different medical centers vary in their control over the indications for genomic sequencing, the level of report interpretation, and the reliability of the results from various sequencing platforms. This article aims to analyze the current status and issues of genomic testing in the diagnosis and treatment of thyroid cancer, combining the authors' personal clinical experience, to discuss the uniqueness and value of genomic testing in the entire management process of thyroid cancer.