AbstractTracheal or laryngeal obstruction in thyroid disease is such a severe, though uncommon, threat that constant awareness of its occurrence and prevention should be the hallmark of the experienced thyroid surgeon. A high index of suspicion, thoughtful analysis of cases, willingness to accept that such a complication does not reflect on the surgeon's competence, and prophylactic elective use of tracheostomy in patients at high risk will afford safety to the patient and peace of mind to the surgeon.