Background <p>Neck discomfort and reduced quality of life (QoL) are common after thyroidectomy. While postoperative neck stretching exercises have shown mixed results, the effect of initiating exercises before surgery has not been adequately studied.</p> Objective <p>To compare the impact of preoperative versus postoperative neck stretching exercises on postoperative neck pain, voice changes, and quality of life in patients undergoing thyroidectomy.</p> Methods <p>This was a single-center, single-blinded, randomized controlled trial conducted at a tertiary hospital in India between August 2022 and August 2024. Adults undergoing thyroidectomy for benign disease were randomized to either Group 1 (exercises starting two weeks preoperatively and continuing four weeks postoperatively) or Group 2 (exercises starting on postoperative day 1 and continuing for four weeks). Both groups followed a standardized neck stretching protocol. Outcomes were assessed using the ThyPRO-39Hin, Voice Handicap Index-10 (VHI-10), Numeric Rating Scale (NRS) for neck pain, and EQ-5D-5&#xa0;L at baseline, 1 month, and 3 months postoperatively.</p> Results <p>A total of 85 patients were randomized (Group 1: <i>n</i> = 42, Group 2: <i>n</i> = 43). Both groups showed significant improvement in ThyPRO-39Hin scores over time, but no significant difference was observed between groups. Voice outcomes (VHI-10) were comparable. However, Group 1 (preoperative exercises) reported significantly lower neck pain scores at 1 month (median NRS 0 vs. 2; <i>p</i> = 0.002) and trend towards a better EQ-5D VAS scores (<i>p</i> = 0.05).</p> Conclusion <p>Preoperative initiation of neck stretching exercises may offer superior early postoperative pain relief and improved perceived recovery compared to starting exercises postoperatively. This low-cost intervention is easily implementable and may serve as a valuable component of surgical prehabilitation in thyroidectomy patients.</p>