While international management guidelines for head and neck cancers exist, they often assume access to reliable cytology, ultrasound, CT scan, MRI and a full spectrum of oncologic treatment including radioactive iodine. However, on the African continent, many surgeons are practicing without the support of reliable diagnostic investigations or essential post-operative care after thyroidectomy such as TSH monitoring, and thyroid and calcium replacement. Therefore many international guidelines have limited value in these settings. The African Head and Neck Society (AfHNS) was established in 2016 by a group of fellowship-trained head and neck surgeons in Sub-Saharan Arica. This society recently met in Cape Town, South Africa, together with surgeons from MD Anderson, Emory, Stanford, John Hopkins, France and Denmark to develop guidelines for the management of thyroid nodules and thyroid cancer in resource limited settings. The Guidelines have systematic algorithms and suggested surgical management strategies for patients with thyroid nodules and thyroid cancer based on the local availability of cytopathology, TSH and calcium testing, thyroid and calcium supplementation, and radioactive iodine. These guidelines have the potential to improve surgical care for patients with thyroid pathology by tailoring the treatment to the safest and most appropriate strategy dependent on resource availability.