Delayed neck haematoma following thyroidectomy is an uncommon but potentially life-threatening complication due to the risk of rapid airway compromise. We report the case of a 62-year-old man with non-valvular atrial fibrillation on rivaroxaban who developed a large anterior neck haematoma on post operative day (POD) 7, three days after resumption of rivaroxaban following an initially uneventful total thyroidectomy and lateral neck dissection. Emergency re-exploration revealed active bleeding from a small superficial vessel between the sternocleidomastoid and platysma, with no haematoma in the deep neck compartment. The patient recovered without further complications after evacuation, haemostatic adjuncts and delayed reintroduction of rivaroxaban. This case highlights potential for clinically significant delayed haemorrhage after thyroidectomy in the context of novel oral anticoagulation (NOAC) therapy, underscores the importance of vigilant post-discharge counselling regarding late warning signs, and supports individualised perioperative anticoagulation strategies for head and neck surgery.