Endoscopic thyroidectomy is a safe and feasible alternative as compared with conventional open thyroidectomy in patients with a small thyroid cancer or a benign thyroid tumor. However, despite the many advantages of endoscopic surgery, it can result in unexpected complications. Recently, the authors experienced a case of follicular thyroid cancer recurrence that developed around the operative bed and along the port insertion site after endoscopic thyroidectomy for a large follicular neoplasm. The authors suggest that a smaller follicular neoplasm is a good indication for endoscopic thyroidectomy, but that a large follicular neoplasm should not be viewed as indicators for endoscopic surgery, because of the possibility of malignancy and rupture during manipulation.