AIM OF THE STUDY: Conservative surgery of thyroid is followed by recurrence in 2 to 70% of cases in an 8 – 20 years period. The surgical treatment of such recurrence is affected by higher morbidity than a primary total thyroidectomy. We wanted verify in our series this difference and discuss motivations for conservative or radical surgery of goiter. MATERIALS AND METHODS: We compared a series of 91 primary total thyroidectomy (A) with 11 cases of total thyroidectomy for recurrence (B) performed between 2001 and 2005. RESULTS: Postoperative complications were: Transient hypocalcemia 7 (7.69%) in A and 3 (27%) in B, Permanent hypocalcemia only 1 (9%) in B, Transient RLN deficit 2 (2.1%) in A and 2 (18.1%) in B. CONCLUSIONS: Due to the need of a lifelong therapy with LT4 no utility is observed in conservative surgery of thyroid. Further, in primary surgery, differences in incidence of perioperative complications cannot be advocated to justify a conservative approach. Sophisticated technologies are not able to prevent all damages to parathyroid or to recurrent nerves when operating on recurrent goiter. Our experience confirms the results of a review of literature on this topic: the best management of recurrent goiter is its prevention by primary total thyroidectomy.