The incidence of severe complications following thyroid gland surgery is a major reason to recommend total thyroidectomy or a less radical procedure in treating thyroid gland diseases. A retrospective study on 335 thyroidectomies was performed to assess the incidence of postoperative complications. Rates for hypocalcemia were based on patients undergoing bilateral procedures (n = 185) and on nerves at risk for recurrent laryngeal nerve injury (n = 513). Permanent hypocalcemia (8%) and unilateral laryngeal nerve injury (2.3%) were the major complications, with 0.8% having fatal complications. The achievement of long-term normal serum calcium levels has been the most frequent complication. Recurrent laryngeal nerve injury had a significant relationship with secondary procedures, histologic findings, and no nerve identification during surgery. In our series, major complications can be blamed on technical pitfalls, even in the hands of experienced surgeons.