Thyroidectomy is performed for nodules with suspicious cytology on fine-needle aspiration (follicular adenoma), biopsy-proven adenocarcinoma, large goiters with airway compromise or cosmetic concerns, or thyrotoxicosis. Given the 6% to 7% incidence of false-negative results on fine-needle aspiration for adenocarcinoma, nodules enlarging on medical therapy should also be treated with operation. Subtotal or total thyroidectomy continues to offer an immediate cure and the best chance of restoring a euthyroid state in certain subgroups of patients with thyrotoxicosis. Included among these are children and women of childbearing age with Graves' disease, those who have failed medical or radioiodine therapy for Graves' disease, those with toxic multinodular goiter (Plummer's disease), and those with toxic adenomas.

Preoperative preparation with antithyroid drugs, propranolol, and potassium iodide (SSKI) or propranolol alone is indicated in patients with thyrotoxicosis to prevent thyroid storm in the postoperative period. Vocal cord function is checked before the administration of paralytic agents by the anesthesiologist. Open thyroidectomy is usually performed under general anesthesia through a low collar incision, yielding excellent cosmetic results. Endoscopic thyroidectomy is also performed under general anesthesia with 3 mm and 5 mm instruments and an endoscope. After preliminary division of the superior thyroid vessels through a 1 cm lateral cervical incision, a 10 mm trocar is inserted through the incision and carbon dioxide is insufflated to a pressure of 10–12 mm Hg.