Purpose Management of patients with thyroid cancer via a multidisciplinary team (MDT) is considered best practice. However, this practice is resource intensive and expensive. To help determine if this represents an effective use of resources, we aimed to determine the degree of adherence to MDT recommendations and the reasons for non-adherence. Methods Thyroid cancer MDT notes and electronic medical records over a 12-month period were reviewed at a tertiary referral centre. The MDT recommendations and the actioned items for each discussion were compared for adherence. For cases with non-adherence, the potential reasons were classified as patient, clinician, disease and system factors. Results Two-thirds of the cases were referred from within our own institution, while the other third were referred from private practice. Cancer diagnosis had been confirmed in 87% of referrals, of which 21% were high risk cancers, and 43% demonstrated metastatic spread. 68% of patients were subsequently treated at our institution. Of the 182 of 236 MDT discussions with follow-up information, the recommendations were fully adhered to in 84%. Partial or non-adherence (10% & 6% respectively) were due to patient preference or non-compliance in 30%, clinician opting for other investigations or treatment modalities in 17%, disease factors in 26.5% and system factors in 26.5%. Conclusion This study highlights the high adherence rate to MDT recommendations. However, some potential areas for improvement had been identified. Ongoing work is being done to determine the variance from ATA guidelines, especially in patients with complex disease factors.