Background: There is a lack of consensus in Europe regarding the management of patients with benign goitre. The object of this study was to find out the long-term results of recommending to patients with clinically and cytologically benign non-toxic goitres not to be operated. Methods: 980 patients were initially referred for surgical evaluation due to non-toxic goitre, 508 of whom underwent directly thyroidectomy. The remaining 473 patients (median age 56 years) were not operated and followed prospectively for a median period of 145 months. Results: During follow-up, 38% of the 473 patients were re-referred to the surgeon for a new evaluation due to different complaints, mainly growth of the goitre and/or worsening of local symptoms. 102 of the 473 patients (22%) had surgery and 27 (5.7%) developed thyrotoxicosis. 14 patients (3%) were diagnosed with thyroid carcinoma, 4 (0.46%) of whom (all elderly women) died of the disease. Conclusions: In patients with non-toxic goitre in whom surgery is not deemed necessary at initial evaluation, a conservative approach is reasonable. There is, however, a small risk for the development of aggressive carcinomas, and a fourth of the patients are operated at a median follow-up of 12 years.