The earliest account of thyroidectomy is probably that given by Roger Frugardi of Salerno in 11701. Thyroidectomy remained a rarely performed procedure, William Halsted2 finding accounts of only eight operations in which the scalpel had been used on the thyroid between 1596 and 1800, and of only 69 more cases between 1800 and 1848. The morbidity and mortality, usually from uncontrolled bleeding and sepsis, were prohibitive but advances in general anaesthesia, antisepsis and haemostasis paved the way for surgeons at the turn of the century to make thyroidectomy a safe and acceptable operation. At the forefront of these developments was Theodor Kocher of Berne3 who performed thousands of thyroidectomies bringing the mortality down to under 1%. Today, thyroidectomy should be an extremely safe and uneventful procedure when performed by a trained endocrine surgeon. The term 'thyroidectomy' embraces a variety of surgical procedures on the thyroid, the precise operation being tailored according to the existing pathology (Table 1). Thyroid nodules are a common disorder occurring in 4% of the population and many of these patients, especially when the lesion is solitary or fine needle aspiration (FNA) has raised the possibility of malignancy, are treated by surgery. Unilateral total lobectomy including the isthmus and pyramidal lobe is the minimum procedure necessary to treat such disease and obtain an adequate histological diagnosis. This operation will therefore be described in detail.