Introduction: The procedure of subtotal thyroidectomy was developed by Theodore Kocher and William Halsted. At around 21st century total thyroidectomy was established as the preferred operation for a range of thyroid pathologies. The indications for total thyroidectomy are thyroid cancers, multinodular goiters (MNG), Graves' disease and other less common conditions, such as thyroiditis. For MNG, the indications of surgery include suspicion of malignancy, either clinically or cytologically, thyrotoxicosis, pressure symptoms, retrosternal extension and occasionally cosmesis. In toxic goiters the indications of surgery may include the following: Moderate to large goiter, resistance to medical treatment, failure of radioactive iodine (RAI) treatment, contraindications for both and significant ophthalmopathy, which may worsen with radioactive iodine (RAI). Although the complications of thyroid surgery are rarely fatal, their consequences can be life-long, but still occurs in a minority of patients. The main complications associated with total thyroidectomy include injury of the recurrent laryngeal nerves, damage to the parathyroid glands and postoperative hematoma.

Aim of the work: The aim of this study was to develop a scoring system to predict the intraoperative challenges during the course of total thyroidectomy.