Objective <p>Tobacco use has been confirmed to be a risk factor for postoperative complications, but the impact of smoking on adverse outcomes following thyroidectomy remains largely unknown.</p> Methods <p>Using data spanning 2016–2020 from the National Inpatient Sample, patients aged ≥ 18&#xa0;years who underwent thyroidectomy for thyroid malignancy or other thyroid disorders were identified and classified into two groups: current smokers and non-smokers. We compared outcome variables between the two groups via univariate analysis and adjusted multivariate logistic regression.</p> Results <p>The present study included 13,737 records of patients who underwent thyroidectomy, among whom 1,360 (9.90%) were identified as current smokers. After propensity score matching, logistic regression analysis suggested that smoking was associated with a heightened risk of unfavorable discharge (aOR = 1.27, 95% CI [1.05–1.54], <i>P</i> = 0.012), vocal dysfunction (aOR = 1.25, 95% CI [1.00–1.55], <i>P</i> = 0.049), hypocalcemia (aOR = 1.23, 95% CI [1.05–1.44], <i>P</i> = 0.010), hypomagnesemia (aOR = 1.58, 95% CI [1.19–2.09], <i>P</i> = 0.001), and respiratory complications (aOR = 1.39, 95% CI [1.16–1.68], <i>P</i> &lt; 0.001). Similar results were observed in both patients who underwent thyroidectomy for thyroid malignancy and those who underwent thyroidectomy for other thyroid disorders when a stratified analysis by surgical indications was performed.</p> Conclusion <p>Smoking is an independent risk factor for adverse clinical outcomes after thyroidectomy.</p>