Background: Thyroid surgery requires a thorough knowledge of the neck anatomy and its anatomical variations. This is of utmost importance, since it is well known that variations of the recurrent laryngeal nerve are prone to iatrogenic injuries. Injury to the recurrent laryngeal nerve is one of the most severe complications of thyroid surgery. Surgeons must have a comprehensive understanding of the anatomy of the recurrent laryngeal nerve during thyroid operation.. Objective: To assess the anatomical variations of recurrent laryngeal nerves and outcome in patients who had undergone thyroid surgery in Tibebe Ghion Specialised hospital, Bahir Dar, Ethiopia. Method: Institutional based cross sectional study was conducted on 102 patients from June, 2021 to August, 2022 G.C in Tibebe Ghion Specialised hospital, Bahir Dar, Ethiopia using nonprobability consecutive sampling technique. Data were analyzed with descriptive data analysis using SPSS 25 version. Results: The findings indicated that several extra laryngeal branches coming off of the recurrent laryngeal nerve on both right and left sides. On the right side, 24.1% (18.4% bifurcations and 5.7% trifurcations) demonstrated branching of the nerve and 10.2% demonstrated branching (bifurcations) on the left side. In relation to inferior thyroid artery, 68.9% of right nerves were related posteriorly, while 27.7% were related anteriorly. On the left side, 91.3% of the nerves were posterior to the artery whereas 7.3% were related anteriorly. The anatomical variation of RLN which interdigitate between branches of the artery were demonstrated in 3.4% and 1.4% on the right and left sides respectively. The relation of recurrent laryngeal nerve with tracheoesophageal groove, was also examined and on the right side, in 93.1% of the cases the nerve was in the groove and it was lateral to trachea in 6.9% of the cases. Of all the patients included in this study 92.2% had uneventful early postoperative period with hoarseness and hypocalcemia occurred in 2% of the cases each. Conclusion: Anatomical consideration of the variations in the course, branching pattern, and relation of recurrent laryngeal nerve with inferior thyroid artery and tracheoesophageal groove is essential to minimize complications associated with surgical procedures of the neck, especially thyroidectomy. Key words: Thyroidectomy, Recurrent Laryngeal Nerve