All the operations were performed by one of the three experienced endocrine surgeons involved in the study. Each of them performed approximately one-third of the operations in each study arm. In the TT group, the operation consisted of extracapsular total thyroidectomy, and in the DO group, the operation consisted of unilateral extracapsular total thyroidectomy and contralateral subtotal thyroid lobe resection (leaving a thyroid stump of approximately 2 g of normal remnant tissue), whereas in the ST group, the operation consisted of bilateral subtotal thyroidectomy (leaving thyroid stumps of approximately 2 g of normal remnant tissue each on both sides of the neck). In each group, efforts were made to identify and remove the entire pyramidal thyroid lobe. In each patient, the recurrent laryngeal nerves were exposed and the branches of the superior and inferior thyroid arteries were divided close to the thyroid capsule (peripheral ligation). Intraoperative nerve monitoring (IONM) was not used for initial surgery in this study. However, IONM was utilized for 15 of 20 (75%) revision operations for recurrent goiter in this study, depending on individual surgical preferences. A lateral approach was routinely used for all reoperative cases. The surgical technique of reoperation for recurrent goiter was described in detail in our previous publication . The parathyroid glands were meticulously dissected from the thyroid gland, and effort was made to identify all the four parathyroid glands and preserve as many as possible “in situ.” Any inadvertently removed parathyroid gland found on inspection to be lying on the thyroid capsule, any gland that was anatomically impossible to be preserved, as well as any devascularized gland were electively reimplanted into the sternocleidomastoid muscle using the standard technique of parathyroid autotransplantation as described by Wells et al. .