Much of the debate regarding the extent of surgical resection in MNG was inspired by the previously reported higher prevalence of permanent morbidity following TT [14–16]. However, more recent data indicate the safety of TT for benign thyroid disease if surgery is performed by high-volume surgeons [2, 5, 7, 11, 12, 17–20], which is also supported by the outcomes of the present study. Patients after procedures more limited than TT are at an increased risk of goiter recurrence and need lifelong surveillance . Subclinical ultrasound-detectable lesions within the thyroid stumps following subtotal thyroidectomy are much more frequent than previously thought, approaching 50% of patients undergoing lifelong follow-up . Some of these ultrasound findings were even the reasons for surgical malpractice claims . However, clinically overt recurrent MNG occurs in up to one-third of patients with ultrasound-detectable lesions, with a peak incidence between 10 and 20 years following the initial procedures more limited than TT . The longer the follow-up period, the higher the prevalence of recurrent goiter. Despite the fact that indications for reoperation for goiter recurrence are rare, the redo surgery may be necessary in approximately 5% of patients following initial subtotal thyroidectomy . Similar observations were made in the present study. However, Delbridge et al.  reported much higher values and showed that subtotal thyroidectomy for MNG resulted in reoperation for recurrent disease in up to 20% of patients, reaching a top incidence 13 years following the primary surgery. According to the 2015 ATA management guidelines, surgery may be considered for growing nodules that are benign after repeat FNA if they are large (> 4 cm), causing compressive or structural symptoms, or the indications may be based upon clinical concerns (Recommendation 27 A) . Moreover, patients with indeterminate nodules who have bilateral nodular disease, those with significant medical comorbidities, or those who prefer to undergo bilateral thyroidectomy to avoid the possibility of requiring a future surgery on the contralateral lobe, may undergo total or near-total thyroidectomy, assuming completion thyroidectomy would be recommended if the indeterminate nodule proved malignant following lobectomy (Recommendation 20 B) . In addition, indications for completion thyroidectomy can be expected in one-third of patients with incidentally diagnosed thyroid cancer following BST . As a result, at least one in ten patients following a procedure more limited than TT may require revision thyroidectomy in the future. It has been repeatedly shown that the risk of repeat thyroid surgery is up to 20-fold higher as compared to the risk of initial TT [3, 4, 23]. Identification and preservation of vital anatomic structures, such as recurrent laryngeal nerves and parathyroid glands, may be compromised during dissection of the scar tissues, leading to a markedly increased prevalence of permanent morbidity following thyroid reoperations. In the present study, the risk of initial TT did not overweight the cumulative risk of postoperative and post-revision permanent morbidity of more limited thyroid resection modes. This evidence is in favor of initial TT for treatment of benign MNG. Nevertheless, recurrent goiter was described even after TT, the condition that is extremely rare (0.3%), and was usually caused by an inadequate resection of embryologic remnant thyroid tissue along the thyrothymic ligament or pyramidal tract . Hence, thyroidectomy with much attention paid to identify and remove the entire thyroid gland along its embryologic descent should effectively eliminate benign goiter recurrence following TT .