Generally, pregnancy is a relative contraindication to surgery. It should be used only in the circumstance where rapid control of hyperthyroidism is required and antithyroid medications cannot be used. Thyroidectomy is best avoided in the first trimester to minimize the chances of birth defects. Third trimester surgery should also be avoided because of the risk of inducing preterm labor. When surgery cannot be avoided, optimal timing for thyroidectomy to be performed is in the second trimester. Certainly, there are surgical and anesthesia risks involved with this and a higher rate of complications is noted. Certainly, any consideration of surgery during pregnancy should be undertaken with a high-volume, very experienced thyroid surgeon. The length of time that a patient spends under anesthesia is also a risk factor and a high-volume surgeon that can more quickly complete the operation can lower those risks.