Purpose <p>Dysphagia following thyroidectomy significantly affects the quality of life in patients with papillary thyroid carcinoma (PTC). However, the risk factors contributing to this complication remain insufficiently explored. This study aimed to identify independent risk factors for postoperative dysphagia in patients undergoing thyroidectomy for PTC.</p> Methods <p>This prospective cohort study included 259 consecutive patients with PTC who underwent thyroidectomy at the First People’s Hospital of Zunyi between May 22, 2024, and October 20, 2024. Dysphagia was assessed using the Functional Oral Intake Scale (FOIS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) one month postoperatively. Logistic regression models and ROC curves were used to identify and validate significant risk factors.</p> Results <p>Layers of neck dissection were identified as an independent risk factor for postoperative dysphagia. Patients undergoing superficial layer dissection had significantly higher rates of dysphagia compared to those with subplatysmal plane dissection (OR = 2.75, 95% CI: 1.51–5.02). The model achieved an AUC of 0.704 (95% CI: 0.639–0.768), with robust results in sensitivity analyses.</p> Conclusion <p>The choice of neck dissection layer significantly impacts postoperative dysphagia. Avoiding superficial layer dissection may reduce this risk, providing guidance for surgical decision-making.</p> Clinical Trial <p>The ID number in the Chinese Clinical Trial Registry is ChiCTR2400083132, and the registration date is April 16, 2024.</p>