The purpose of this study was to identify the value of performing total thyroidectomy in Hashimoto?s thyroiditis (HT) patients with persistent preoperative symptoms despite conservative medical therapy. Additionally to identify the value of performing early total thyroidectomy in HT patients with mild to moderate preoperative symptoms without depending on medical therapy and detect the frequency of improvement of the symptoms after thyroidectomy in both conditions. Methods: we have included 60 patients in our study who were diagnosed clinically and laboratory as having HT we divided all patients into 2 groups group 1 included 30 patients who were subjected to early total thyroidectomy and group 2 that included 30 patients and subjected to supervision and follow-up of clinical and laboratory symptoms without performing total thyroidectomy. Patients of group 1 were subjectively evaluated for occurrence of postoperative improvement, relief of symptoms or occurrence of complications. Results: we detected that there is marked improvement in post- thyroidectomy in patients of group 1 in clinical annoying symptoms; serious tiredness, compression, voice problems (p<0.001), and there is marked improvement in level of antibody titers after follow-up; anti-TPO antibodies, high anti-TG antibodies (p<0.001). In group 2 patients; we detected that there is marked deterioration in clinical annoying symptoms; serious tiredness, compression, voice problems (p<0.001), and there is marked increasing in level of antibody titers after follow-up; anti-TPO antibodies, high anti-TG antibodies (p<0.001). Conclusion: we have proved that total thyroidectomy for management of HT patients is an operation that can be safely performed, with low incidence of permanent complications. Therefore, HT patients will be advised to do Total Thyroidectomy early in such patients that will make antibodies disappear, improve autoimmune symptoms and decrease the incidence of postoperative complications.