Background: Non toxic multinodular goiter had been treated primarily by subtotal thyroidectomy, but the high incidence of recurrences and the higher risk of morbidity following a second operation lead to the introduction of total thyroidectomy as an alternative procedure.Objectives: To compare the safety and the efficacy of total thyroidectomy with subtotal thyroidectomy for treatment of nontoxic multinodular goiter.Methods: Six hundred forty cases were assessed preoperatively clinically and biochemically by thyroid function tests, U/S of the neck & thyroid scan, serum calcium level, indirect laryngoscopy,x-ray of the soft tissue of the neck and thoracic inlet, Chest x-ray and ECG. 494 cases were treated by total thyroidectomy, 146 cases were treated by subtotal thyroidectomy.Results: Total thyroidectomy was conducted in 74% of the cases while only 26% of patients underwent subtotal thyroidectomy. Temporary recurrent laryngeal nerve palsy occur in 3% of cases in the first group and 0.6% in the second group. Permanent recurrent laryngeal nerve palsy was not reported in both groups. Temporary hypoparathyroidism was reported in 6.9% of the cases in first group and in 2.7% of the cases in second group. In first group 1.4% of the cases develop permanent hypoparathyroidism, while no case of the second group developed this complication. Only one patient (0.6%) of the subtotal thyroidectomy group developed immediate post operative hemorrhage that needs urgent reexploration which was not reported in the total thyroidectomy group. Acute laryngeal edema occurs in 0.6% of the cases in the first group and in 1.4% of the cases in the second group.Conclusion: Total thyroidectomy had been found to be safe with comparable rate of complications with subtotal thyroidectomy as primary management of bilateral nontoxic multinodular goiter.