In a systematic review and meta-analysis of 11 cohort studies including 427,886 patients, those aged 65 years or older undergoing thyroidectomy had higher rates of recurrent laryngeal nerve injury (2.3% vs 1.0%), hematoma (2.4% vs 1.0%), and mortality at last follow-up (0.3% vs 0.01%) compared with younger patients, while rates of hypocalcemia and wound complications were similar. Despite these statistically higher risks, absolute differences were small, supporting the overall safety of thyroidectomy in older patients.