OBJECTIVES/HYPOTHESIS Thyroidectomy has historically been performed on an inpatient basis out of fear of hemorrhage and transient but life-threatening hypocalcemia. An earlier favorable experience with outpatient surgery for a limited number of patients prompted our objective of an expanded evaluation of this practice. STUDY DESIGN Retrospective analysis of a prospectively populated database. METHODS A consecutive single-surgeon series of patients undergoing thyroidectomy in an academic otolaryngology department between February 2003 and November 2007, including 91 patients assessed in a previous report. Clinical variables including age, gender, type of surgery, indications, and complications were obtained and analyzed. Principal outcome measures were length of hospital stay, incidence of complications, and rate of readmission. RESULTS Four hundred eighteen patients underwent thyroid surgery during the study period. Two hundred eight were accomplished on an outpatient basis, 128 patients were observed under a 23-hour status, and 82 were admitted for a mean of 2.9 days (the latter two cohorts were grouped together and designated as inpatients). There were four complications in the outpatient group (1.9%) and 28 (13.3%) in the inpatient group (P < .001). Four individuals in the outpatient group (1.9%) required readmission compared with 5.7% (12/210) of those in the inpatient group, most commonly for transient hypocalcemia. CONCLUSIONS The initial favorable experience with outpatient thyroid surgery has been validated in this expanded patient population of more than 200 patients. In rare instances, readmission may be required secondary to transient hypocalcemia. Modern surgical techniques, avoidance of drains, and prophylactic calcium supplementation have combined to make outpatient thyroidectomy safe in carefully selected patients.