The identification of the risk factors associated with the increased incidence of the nerve injury is of paramount importance. Twenty-nine of 581 patients who developed recurrent laryngeal nerve palsy after thyroidectomy were analyzed retrospectively. There were 23 women (79%) and 6 men (21%), with a mean age of 45.6 years (range, 22-66 years). Eleven patients had right vocal cord paralysis, 8 had left vocal cord paralysis, and 10 patients had bilateral involvement. Ten patients underwent near total thyroidectomy (34.4%), eight patients underwent bilateral subtotal thyroidectomy (27.5%), six patients underwent total thyroidectomy (20.7%), and five patients underwent unilateral lobectomy (17.2%). Four of 10 patients with bilateral vocal cord paralysis had a unilateral nerve injury detected with laryngoscopy before surgery. Only five patients developed permanent vocal cord paralysis (17%). Three patients with permanent paralysis underwent reoperative thyroid surgery and had a total lobectomy. One patient required a tracheostomy, and arytenoidectomy was performed in one patient at a later follow-up period. Most recurrent laryngeal nerve palsy after thyroidectomy was transient. Permanent paralysis is associated with reoperative thyroid surgery.