ABSTRACT Background: Thyroidectomy is among the most common surgical procedures worldwide. It is associated with complications which significantly impact patient’s quality of life and healthcare resources. In Ethiopia, particularly at Tibebe Ghion Comprehensive Specialized Hospital, there is a lack of data regarding proportion and associated factors of these complications. Objective: To determine the proportion of complications and its associated factors among patients who underwent thyroidectomy at Tibebe Ghion Comprehensive Specialized Hospital, Bahir Dar city, Ethiopia. Methods: A cross-sectional study was conducted among 244 patients who underwent thyroidectomy. Data were collected from medical records using a structured checklist, and the data were analyzed using IBM SPSS Statistics version 27. Simple and multivariable logistic regression analyses were used to assess the association between the risk factors and post-thyroidectomy complications. Statistical significance was set at p < 0.05. Results: The study included 244 participants (87.3% female; mean age 43.68 years). The proportion of early and late complications was 28.7% and 16.9%, respectively. Transient hypocalcemia (16.4%) and unilateral recurrent laryngeal nerve injury (8.2%) were the most frequent early complications. Multivariable analysis revealed that extensive (subtotal and total) thyroidectomy (AOR = 3.040; 95% CI: 1.364–6.777, p = .007) and compressive symptoms (AOR = 3.115; 95% CI: 1.389–6.985, p = .006) were associated factors of early complications. For late complications, advanced age (AOR = 1.049) and extensive surgery (AOR = 2.401; 95% CI: 1.010–5.709, p = .048) were identified risk factors, while intraoperative identification of parathyroid glands was protective factor (AOR = 0.358; 95% CI: 0.134–0.956, p = .040). Conclusion: rate of complications in our study were higher than reported across various literatures. Early complications extend hospital stay. Extensive surgery, compressive symptoms and older age increase the risk of complications. Intraoperative identification of parathyroid glands reduces long-term morbidity. Standardized postoperative patient monitoring, calcium supplementation for high-risk procedures is recommended. Surgeons should prioritize the visual identification of vital structures to minimize complications.