Surgical drains are routinely placed following thyroidectomy to prevent hematoma formation; however, their necessity remains debated. This multicenter randomized controlled trial evaluated the impact of drain placement on postoperative outcomes in patients undergoing total or near-total thyroidectomy. A total of 300 patients were randomized into two groups: drain placement (n=150) and no drain (n=150). The primary endpoint was the incidence of postoperative complications, including seroma formation, hematoma, and wound infection. Secondary outcomes included postoperative pain, hospital stay duration, and quality of life assessment. Patients in the no-drain group exhibited significantly lower pain scores (mean ± SD: 3.2 ± 1.1 vs. 5.4 ± 1.3, p<0.001) and shorter hospital stays (1.2 ± 0.5 vs. 2.6 ± 0.9 days, p<0.001). Seroma formation was slightly higher in the no-drain group (6.7% vs. 3.3%, p=0.048), but no significant differences were observed in major complications, including hematoma or infection (p>0.05). The findings suggest that routine drain placement may not be necessary, as it does not significantly reduce major complications but is associated with increased pain and prolonged hospitalization. This study provides robust evidence that supports a shift in surgical practice towards selective drain use rather than routine placement after thyroidectomy.