Objective：To observe the clinical effect of surgical treatment combined with 131I therapy on differentiated thyroid carcinoma (DTC). Methods：One hundred and forty-two patients with DTC undergoing subtotal or total thyroidectomy along with selective neck dissection from January 2000 to December 2004 in our hospital were included. After operation 90 cases given 131I ablative therapy combined with replacement therapy of thyroxine tablets were assigned as group A, and 52 cases given thyroxine tablets alone without 131I therapy were assigned as group B. Results：In group A, the thyroid remnants of patients were all fully ablated after 1-4 courses of 131I treatment and the success rate of first course was 71.1%; the total response rate of metastasis therapy was 91.1%, in which the response rates were 95.1%, 88.9% and 72.7% for lymph nodes metastasis, lung metastasis and bone metastasis, respectively. The incidence of adverse reactions was significantly different between the patients with total thyroidectomy (42.0%) and with subtotal thyroidectomy (77.5%) (P＜0.01). The recurrence and survival rate for 10 years following surgery was 6.7% and 94.4% in group A and 19.2% and 80.8% in group B, and both were significantly different beween the two groups (both P＜0.05). Conclusions：Surgical treatment combined with 131I treatment and thyroid hormone replacement therapy have good efficacy for thyroid ablation and metastasis therapy, which effectively reduces recurrence and metastasis rate of DTC after surgery and also shows good long-term effects.