Transoral thyroidectomy is a newly developed surgical procedures in recent years. Surgical space is established through vestibule of the mouth. This procedure is indicated for thyroid benign lesions and thyroid cancers without evident lateral cervical metastasis. Its advantages include scarless neck; relative near surgical route; good exposure and treatment of bilateral thyroid glands with central compartment dissection simultaneously. This case was diagnosed as thyroid cancer and received transoral total thyroidectomy with central compartment neck dissection. During the operation, superior parathyroid glands and the recurrent laryngeal nerve were clearly exposed and protected. Harmonic scalpel was used to safely and stably cut off superior and inferior thyroid arteries with less blood loss and clear surgical field. No drainage tube was needed in this procedure. The postoperative complications mainly included pain and para-lower lip numbness, which could recover from appropriate rest and application of postoperative analgesic. Transoral thyroidectomy is a safe and effective surgical procedures only if rigid selection of cases and surgeons with rich experiences are guaranteed.