Background: Despite a well-established endemicity of Goiter in Tanzania little work has been done on management of goiters in Tanzania. Thyroid surgery has been reported to be the mainstay of the treatment of goiters and is considered as a safe procedure in well-equipped settings and with people having suitable experience to anticipate and avoid the occurrence of possible surgical complications. Objectives: To determine prevalence of goiter, histological patterns and outcome of patients operated at KCMC hospital surgical unit. Method and tools: This was a Retrospective Cohort study conducted between May 2016 and July 2016, data were extracted from the patients’ files using data collection sheets. Results: The prevalence of goiter among patients admitted at KCMC hospital surgical unit between January 2013 and December 2015 was 432(5.1%). Majority of patients included in this study i.e. 141(65.6%) presented with non-toxic symptoms while the remaining 74(34.4%) patients had toxic symptoms. Clinically, Multinodular nontoxic goiter and simple goiter were the commonest diagnoses accounting for 47(21.9%) of all cases each. Benign multinodular goiters were the most common histopathological pattern accounting for 99(60.7%) of 163cases. 18 (11%) patients were proved histologically that they had thyroid malignancy, of which follicular and papillary carcinoma were reported in 8(44.4%) and 4(22.2%) cases respectively, 2(11.1%) had mixed (follicular and papillary) while the remaining 4(22.2%) had other type i.e. Hulthle cell carcinoma and atypical cell carcinoma. Cosmetically disfiguring enlargement and pressure (compressive) symptoms were the common indications for thyroidectomy in 136(63.3%) and 31(14.4%) respectively. Total thyroidectomy, near total thyroidectomy, subtotal thyroidectomy, partial thyroidectomy and Hemithyroidectomy were the surgical procedures performed for benign and malignant goiters in almost all patients. Post-operative complications rate was 8.2%. The mean length of hospital stay post operation was 2.93days (ranging from 1 to 19 days). Conclusion: This study has shown that the histopathological pattern of goiters seen at KCMC hospital being similar to those reported from other settings in the world. And despite thyroid surgery being said to be a safe procedure we still encounter some complication which are known to happen during this procedure and preventable.