The detection of nonpalpable recurrent thyroid carcinoma has increased due to the use of imaging techniques in time. This report is to investigate whether preoperative injection of a radiotracer under ultrasound guidance is useful in nonpalpable recurrent thyroid carcinoma. The neck of two patients with recurrent thyroid carcinoma was scanned with the probe to localize the area of maximal radioactivity allowing appropriate location of the incision over the lesion. After the lymph nodes were removed, radioactivity was measured in the lesion bed to confirm the success of the dissection. In conclusion, the radio-guided nonpalpable lesion localization technique can be performed safely for the detection and excision of metastatic foci.