Identification and preservation of the recurrent laryngeal nerve is a major concern during thyroidectomies. The Zuckerkandl tubercle is an anatomic landmark that can be used for this purpose. It is generally found in 63% to 80% of patients undergoing thyroidectomy and is located between the superior and inferior lobes and points toward the tracheoesophageal groove. It is classified into three grades according to size: I <.5 cm, II .5 to 1 cm, III >1 cm. A grade III tubercle, present in 45% of patients, is sometimes associated with significant pressure symptoms in otherwise small-sized goiters.