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From November 1970 to July 1983, a total of 322 thyroid cancers were treated surgically in our clinic. Total thyroidectomy was the treatment of choice. In 131 patients, modified neck dissection (unilaterally in 23 and bilaterally in 108) was added. Of the latter patients, 33 also required upper mediastinal lymph node dissection. There were no operative deaths. No recurrent laryngeal nerve iatrogenic palsy was observed. Permanent parathyroid insufficiency developed in only about 4% of patients. The low morbidity and good long-term results justify the use of this procedure in all patients with thyroid malignancies. Despite conservative arguments in the controversial issue of lobectomy versus total thyroidectomy, skilled surgeons should be able to perform total thyroidectomy safely. It is recommended as the treatment of choice because of the well-documented multicentricity of thyroid cancers and the good prognosis of differentiated cancers associated with a near-normal life expectancy, to permit radioactive iodine therapy of possibly functioning metastases and the easier control of hypothyroidism with thyroid supplement medication.