Nikolai Ivanovich Pirogov (1810–1881) was a genius of Russian surgery. In 1831 at the age of 20, at a written test to defend his Doctor of Medicine degree, he presented his understanding of the structure and function of the thyroid and the major checkpoints of thyroidectomy. He was pretty accurate in describing thyroid morphology and clinical features of thyroid disease, and also drew important conclusions about ways to prevent dangerous complications during thyroid surgery. Pirogov described approaches to the thyroid (“elliptic, longitudinal, cruciform neck cuts”), and stages of thyroidectomy (“bilateral ligation of the superior thyroid arteries…exposure of the thyroid…ligation of the inferior thyroid artery”) in detail. Pirogov wrote: “Prior to extirpation, ligation of the superior thyroid artery should be performed and preferably on both sides. Regarding the inferior thyroid artery, due to its deep location under the gland, it has to be ligated after the lower end of the thyroid is lifted…”. In May 1847 in St. Petersburg he performed a number of experiments with ether anesthesia in animals and on himself, and was the first in the world to perform thyroid resection under general anesthesia, less than a year after the beginning of clinical use of ether by Dr. John Warren (USA). Similar operations were performed in 1852-1853, again, using 30-40 ligatures, which was unusual in European surgical practice at that time. In 1847, in Vladikavkaz, Russia, Nikolai Pirogov was the first surgeon to use general anesthesia during a thyroidectomy.2 The patient was a 17-year-old girl with a goiter causing compression of the trachea.15 The surgery was quite difficult since the “tumor was of a size of an apple” and “more than 30 ligatures were required.” The wound healing was complicated “with pus.” The outcome of surgery was nevertheless a success. Soon Pirogov performed three more thyroid surgeries in St. Petersburg.