Abstract: The recurrent laryngeal nerve of giant thyroid is prone to temporary neurological paralysis and injury due to mutation. The authors performed thyroid surgery in the whole process of recurrent laryngeal nerve in 11 years. The paralysis rate and injury rate after recurrent laryngeal nerve surgery were reviewed. RESULTS: Among 2051 patients, the incidence of giant thyroid recurrent laryngeal paralysis accounted for 11.85% of all goiters. It was evident in all cases (p<0.001), and the incidence of recurrent laryngeal nerve injury was also significant ( p=0.006). Conclusion: Giant goiter is prone to temporary paralysis and injury due to variability of the recurrent laryngeal nerve. Surgery should be precisely protected.