Objective To explore the safety of total thyroidectomy surgery on patients with thyroid carcinoma. Methods From Jan 1986 to Dee 2006, clinical data of patients who underwent total thyroidectomy (total thyroidectomy group) and sub-total or near-total thyroidectomy surgery (control group) for thyroid carcinoma were retrospectively analyzed to identify the incidences of complications, recurrent laryngeal nerve paralysis (RNLP) and secondary hypoparathyroidism in the two groups. Results In the control group there were 433 thyroid carcinoma patients who underwent sub-total or near-total thyroidectomy. Transient unilateral RLNP(13 eases), permanent unilateral RLNP(5 eases), transient hypoparathyroidism (11 cases) was diagnosed. There was no permanent hypoparathyroidism in this group. In the 70 cases of thyroid carcinoma patients receiving total thyroidectomy, there were 4 eases suffering from transient unilateral RLNP, one case from permanent unilateral RLNP (P > 0.05), and there were 7 eases from transient hopyparathyroidim (P < 0.01), 2 eases from permanent hypoparathyroidism (P < 0.05). Conclusion The incidence of RLNP after total thyroidectomy was not higher than that after subtotal or near-total thyroideetomy. Postoperative hypocalcaemia was the most common postoperative complication of total thyroidectomy. It is our belief that total thyroidectomy should be performed in selected patients.