Abstract: Thyroid cancer is the malignant tumor with the most rapidly increasing incidence in recent years, the overwhelming majority of which are derived from follicular cells. The most common tumor entity is differentiated thyroid cancer, which could be divided into papillary thyroid cancer and follicular thyroid cancer. The accurate pathological diagnosis of thyroid cancer is the cornerstone in the process of precision medicine which includes prevention, diagnosis and treatment. This review discusses the significance of accurate pathological diagnosis in the precision medicine of thyroid cancer based on the following four aspects: 1) the risk evaluation of thyroid cancer, 2) preoperative accurate diagnosis of thyroid nodules, 3) the risk stratification of prognosis and recurrence, and 4) the guidance of molecular targeted therapy in advanced patients.