Total thyroidectomy is considered as the standard surgical procedure for most malignancies and benign disease involving both lobes of the thyroid gland. Postoperative complications are likely to be commoner when the thyroid gland is large in size due to the alteration of structural anatomy.

Postoperative complications of 102 patients who underwent total thyroidectomy for benign disease, by the same surgeon, were analyzed. Patients were prospectively followed up and presence of hoarseness and hypocalcemia, both transient and temporary, were compared with the weight of the gland.

Fourteen patients developed hypocalcemia of which 12 (11.7%) had transient and 2 (1.96%) had permanent deficiencies. Eight patients developed hoarseness following surgery of which seven (6.86%) had transient and only one (0.98%) had permanent hoarseness. A mean thyroid weight of 91.78 gm was observed in the uncomplicated group. Those who developed postoperative hypocalcemia and transient hoarseness had a mean thyroid weight over 100 gm. One patient, who had a thyroid weighing 195 gm developed permanent hoarseness due to RLN injury.

There is no statistically significant difference in the incidence of transient RLN and transient or permanent hypocalcemia. With increased size of the thyroid gland increased rate of complications was observed with a mean thyroid weight above 100 gm. There may be a significant risk of permanent RLN injury when the thyroid gland is enlarged over 10 times (closer to 200 gm) its normal size.