Thyroidectomy is a routinely common practiced surgery. Morbidity and mortality from thyroid surgery are disregarded nowadays and undervalued in the literature. Perioperative risks and complications still exist for large goiters and can be life-threatening. These complications may occur during the anesthesia and intubation, intra-, or postoperatively. We set out through a case of a large cervical multinodular goiter (MNG) and a review of literature the perioperative complications and how to avoid them. During the total thyroidectomy operation, an accidental devascularisation of a parathyroid gland, a cervical hematoma which was evacuated by surgical reoperation, hemodynamic disorder and a transitory hypoparathyroidism were the postoperative complications that occurred. Surgery for large goiters remains difficult; so adequate preoperative assessment, particular attention and careful operative procedure should be followed to obtain better surgical outcomes.