The indications for an up-front total thyroidectomy in cases with Bethesda III/IV lesions included concurrent Graves’ disease (n = 2), bilateral multinodular goiter (n = 1), preoperatively verified papillary thyroid carcinoma (PTC) on the contralateral side (n = 1), and a follicular tumor with an augmented Ki-67 proliferation index at 10% preoperatively (n = 1). The gene discussed is MKI67; the disease is multinodular goiter.