Abstract. The cornerstone of safe and effective thyroid surgery is thorough training in and understanding of thyroid anatomy and pathology. With appropriate techniques, total thyroid lobectomy and total thyroidectomy (which should be considered simply as a bilateral total thyroid lobectomy performed during the same operation) can be undertaken with minimal risk of damage to the recurrent laryngeal nerves, the external branches of the superior laryngeal nerves, and the parathyroid glands. Safe surgery requires a specific operative plan, progressing in a series of logical, orderly, anatomically based steps. Exposure of the thyroid gland is followed by careful dissection of the superior pole, utilizing the avascular plane between the superior pole and the cricothyroid muscle to identify and preserve the external branch of the superior laryngeal nerve. Medial retraction of the gland then allows dissection of the lateral aspect of the thyroid lobe. Protection of the recurrent laryngeal nerves and preservation of the blood supply to the parathyroid glands is best achieved by "capsular dissection," ligating the tertiary branches of the inferior thyroid artery on the gland surface. If a parathyroid gland cannot be preserved or becomes ischemic after dissection of its vascular pedicle, it should be immediately minced and autotransplanted into the ipsilateral sternocleidomastoid muscle. The current evolution of outpatient or shortstay thyroidectomy emphasizes the need to avoid complications by utilizing meticulous surgical technique. Minimally invasive thyroidectomy utilizing endoscopic techniques may also affect the practice of thyroid surgery. Even so, understanding the surgical anatomy of the thyroid gland and its possible variations is paramount to safe and effective surgery.During the latter half of the nineteenth century a revolution in surgery and surgical technique occurred. Before that time, thyroid surgery was limited to treating only life-threatening conditions. With a reported mortality rate of more than 20%, the reputation of thyroid surgery was so poor that the French Academy of Medicine banned its practice in 1850. Indeed, when Greene reported his successful thyroidectomies in America, he warned that the operations should be used "never, for the relief of deformity or discomfort merely; only, to save life" [1]. However, by the time the Nobel Prize was awarded to Kocher in 1909, the mortality rate in his hands had been reduced to 0.18% [2].The key to increasing safety of thyroid surgery was then, as now, a thorough understanding of thyroid anatomy and pathology. The general developments in surgical techniques and instrumentation, and the improvements in antisepsis and anesthetic techniques, were also crucial. When thyroidectomy became safe to perform, the specific complications of the procedure could be addressed, including prevention of injury to the recurrent laryngeal nerves and avoidance of accidental injury to, or removal of, the parathyroid glands. The surgical techniques developed at that time were, i...

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Surgery in patients over 75 is as safe as in younger patients with no increase in morbidity and mortality. Benign multinodular goitre is the most common indication for surgery.

Unexplained cardiopulmonary dysfunction, particularly after the institution of beta blockers, should alert clinicians to the possibility of phaeochromocytoma. A high index of suspicion is essential to reduce morbidity and mortality in these patients through early diagnosis and aggressive management.