Management of toxic multinodular goiter (TMNG) is still debated. We report our current experience with thyroidectomy for toxic multinodular goiter at a tertiary center. A retrospective database of 141 patients who underwent surgery for TMNG disease from January 1985 to December 2008. During that period, six patients underwent subtotal thyroidectomy and 135 patients underwent near total thyroidectomy. Around 53 patients (38%) underwent surgery for recurrent disease after medical therapy; 88 patients (62%) had surgery as a primary treatment, the indications were large goiter size in 58 (66%), associated cold nodule in 16 (18%), patient preference in 14 (16%). The incidence of cancer was 6.4%. Permanent hypoparathyroidism was observed in two patients. Unilateral transitory vocal cord palsy was observed in 11 patients (8%), no bilateral transitory vocal cord palsy was observed. One unilateral definitive vocal cord palsy was observed and was provoked by a mediastinal compression. Two patients (1.5%) experienced postoperative hemorrhagia requiring surgical revision. Near total thyroidectomy for TMNG provide an immediate and definitive treatment with a low complication rate. Near total thyroidectomy offers an appropriate treatment for coexisting malignancy. Only NTT can alleviate compressive symptoms. This procedure can be safely recommended even as a primary treatment.