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Abstract: Background: Rates of complications of thyroidectomy, mainly hypocalcemia and recurrent laryngeal nerve injury, can be higher in certain patient groups. There are several risk factors for complications published in the literature, among them are malignancy, bilateral resection, younger age, and Graves disease.4,5 To our knowledge,there is not a study that examines the role of thyroid size as an independent risk factor in total thyroidectomy. Methods: A case-control study carried out at a tertiary, academic medical center involving patients who underwent total thyroidectomy between August, 2001 and March 2005. Pathology reports were reviewed for gland weight, size and histology, and anesthesiology reports were reviewed for estimated blood loss (EBL), American Society of Anesthesiologist score (ASA) classification and duration of surgery. Hard copies of charts were reviewed for calcium replacement as well as for length of hospital stay. Results: Thyroid size had a positive correlation of 0.34 (N = 49) (P = 0.02) with length of surgery and 0.32 correlation (P = 0.04) between increasing thyroid size and increased hospital stay. Thyroid weight (N = 50) had a positive correlation of 0.47 (P<0.001) with estimated blood loss as did thyroid volume (N = 51) with a similar correlation of 0.49 (P<0.001). The correlation with calcium nadirs was found to be —0.27 (P= 0.05). Hypocalcemia symptoms occurred in 13.4% of patients (N=7), all of which were female, otherwise age, BMI and thyroid weight and dimensions were statistically insignificant. Drain output is positively correlated as well with thyroid weight and dimension, 0.39 for weight (P=0.008) and 0.40 for dimension (P=0.006). Overall, 40 % of patients (N=21) had ionized calcium values below 1.0 mmol/L. Recurrent laryngeal nerve injury (N=2) occurred in 3.9%. Conclusion: Increased thyroid size does appear to portend and increase in peri-operative complications including increased blood loss, lower hypocalcemia nadirs and overall number of complications. There is also a positive correlation with time spent in surgery,and days spent in the hospital.'