Patellogastropods, also known as true limpets, are distributed throughout the world and constitute key species in coastal ecosystems. Some limpet species achieve remarkable sizes, which in the most extreme cases can surpass 35cm in shell length. In this review, we focus on giant limpets, which are defined as those with a maximum shell size surpassing 10cm. According to the scientific literature, there are a total of 14 species across five genera that reach these larger sizes. Four of these species are threatened or in danger of extinction. Inhabiting the intertidal zones, limpets are frequently affected by anthropogenic impacts, namely collection by humans, pollution and habitat fragmentation. In the case of larger species, their conspicuous size has made them especially prone to human collection since prehistoric times. Size is not phylogeny-dependent among giant limpets, but is instead related to behavioural traits instead. Larger-sized species tend to be nonmigratory and territorial compared to those that are smaller. Collection by humans has been cited as the main cause behind the decline and/or extinction of giant limpet populations. Their conspicuously large size makes them the preferred target of human collection. Because they are protandric species, selectively eliminating larger specimens of a given population seriously compromises their viability and has led to local extinction events in some cases. Additionally, sustained collection over time may lead to microevolutionary responses that result in genetic changes. The growing presence of artificial structures in coastal ecosystems may cause population fragmentation and isolation, limiting the genetic flow and dispersion capacity of many limpet species. However, when they are necessitated, artificial structures could be managed to establish marine artificial microreserves and contribute to the conservation of giant limpet species that naturally settle on them.