The patient, a 73-year-old female with a history of several decades, had progressive bilateral enlargement of the anterior neck area for decades and was diagnosed with diffuse giant goiter. She had been treated in local hospitals in the northeast, but her condition continued to progress and her neck gradually thickened. The patient’s neck was severely deformed and she had been transferred to Beijing, Shenyang, Jinan and many other places accompanied by her family. Experts in many places did not dare to operate on the goiter because it was huge. When the patient came to the hospital, the doctor carefully analyzed the case and concluded that the surgery would involve numerous blood vessels and nerves in the neck, and that it could still be done easily despite being a challenging and demanding surgery. The surgery was scheduled for one afternoon in June 2015, and Director Yan Jiqi performed a bilateral total thyroidectomy, which revealed a 22x10x8cm thyroid on the right side and a 15x7x6cm thyroid on the left side, with part of the thyroid reaching deep behind the sternum. The irregularly growing thyroid gland was compressing the bilateral cervical vessels, and the trachea was obviously compressed. Dr. Yan Jiqi performed a very beautiful butterfly total thyroidectomy to remove the huge and irregular thyroid glands bilaterally together with the isthmus without disconnecting the bilateral anterior cervical muscles. The important anatomical structures such as the recurrent laryngeal nerve and the parathyroid glands were successfully preserved. Since the anterior cervical muscles and the isthmus were not removed, the operation time was greatly reduced. The operation that would have taken other surgeons at least 3-4 hours to complete, took less than 90 minutes from skin to skin, thanks to the efforts of Dr. Jiqi Yan’s team. In total, Dr. Jiqi Yan’s team performed four different types of thyroid surgeries that afternoon. Due to the precision of the surgery and the short time it took, the patient was successfully extubated after the surgery. And there were no complications related to hoarseness, hand and foot hypocalcemic convulsions, etc. after the surgery. The patient recovered well and remained in accordance with the hospital’s postoperative thyroid surgery routine and seemed to be discharged two days after surgery. The reason for this is the lack of precise knowledge of the anatomy of the neck, the unnecessary severance of the anterior cervical musculature, the rudimentary recognition of the anatomy of the laryngeal recurrent nerve and parathyroid glands, and the lack of mastery of the technique of pterygoid thyroidectomy, which results in unnecessary loss of surgical time to the patient’s anatomical space and therefore greatly affects the surgical Therefore, the results of the surgery are greatly affected.