The major strength of this study is that it is an RCT with a long-term follow-up of 10 years that allowed for an objective estimate of the treatment effects of utilizing different thyroid resection modes for patients with MNG. On the other hand, the study protocol has several limitations that should be taken into consideration. First, patients included into this study were recruited from the southern part of the Polish territory that historically has been classified as an iodine-deficient area and endemic goiter area according to the International Council for Control of Iodine Deficiency (ICCIDD) criteria. Hence, primary outcomes of this study may not be universally translated into other cohorts of patients with MNG, particularly living in iodine-sufficient areas of the world. However, we believe that in iodine-deficient areas both iodine prophylaxis and levothyroxine treatment are needed for efficient long-term prevention of goiter recurrence following other than total thyroidectomy . In addition, all the operations in this study were performed by high-volume thyroid surgeons performing more than 200 thyroid operations annually each. Hence, the prevalence of surgical morbidity reported in this study cohort may not be achievable for low-volume thyroid surgeons. Adam et al.  reported recently that 81% of all thyroid surgeries in the USA were undertaken by low-volume surgeons and 51% of surgeons performed only 1 case per year. Thus, more limited thyroid resections for benign thyroid disease may still be a safe and effective alternative for low-volume surgeons, whereas TT should be reserved for high-volume thyroid surgeons. Last but not least, the novel surgical adjuncts having a potential for improving functional outcomes of thyroidectomy, such as IONM of the laryngeal nerves or near-infrared fluorescence technique for parathyroid imaging, were not utilized in this study for initial surgery. However, one can expect that the rising popularity of these adjuncts in the future can make safe TT at experienced hands even safer [25, 26]. Encouraging data were recently published by Wojtczak et al.  who found that experience with IONM led to an increase in RLN identification, a decrease of RLN injury, and an increase in the safe utilization of TT in non-monitored thyroid operations. Thus, if surgery is chosen as definitive treatment for MNG and the permanent complication rate can be kept below 2%, TT should be recommended, as it prevents recurrent nodular goiter and eliminates the risk of reoperation in the future.