This retrospective study (1986-1996) investigated 60 patients after total thyroidectomy indicated by a differentiated thyroid carcinoma. Analyzing the rate of paralysis of the recurrent nerve after secondary thyroidectomy due to the timing of the second operation, we found that only patients with secondary thyroidectomy having their second operation at an interval > 7 days suffered from permanent paralysis of the recurrent nerve. In conclusion, a second radical surgical procedure must be performed as early as possible to minimize complications.