Purpose Post-operative care following thyroidectomy usually includes at least an overnight hospital stay due to risks of hypocalcaemia and haemorrhage. Internationally, many centres are moving to same day thyroidectomy. NSW Health recommends a target of 15% for same day thyroidectomy, yet in 2024, only 2% achieved this goal. The purpose of this study was to review the evidence base, propose guidelines for same day thyroidectomy appropriate to Australian health care settings, and then determine the percentage of patients who might be suitable. Methodology International guidelines were reviewed and synthesised. Local guidelines appropriate to our health context were proposed. A retrospective audit of all thyroidectomies from John Hunter Hospital during 2023 was performed. Results Local guidelines included patient eligibility criteria, discharge criteria and a pathway for representation to hospital. Guidelines were deliberately conservative, with the intent to consider broadened criteria if initial implementation was successful. Patients considered eligible for day case thyroidectomy included: aged <75, good social support (responsible adult to stay with patient overnight) and geographical proximity (<30 minutes drive) to the hospital). Exclusion criteria included bilateral thyroid surgery, major medical or psychological comorbidity, anticoagulation or antiplatelet use, or previous neck surgery. Of the 157 thyroidectomies performed in 2023, 19 patients (12%) met eligibility criteria. Conclusion Same day thyroidectomy may be appropriate in well selected patients but requires system change focussed on patient safety. The target of 15% same day thyroidectomy set by NSW Health seems aspirational in our patient cohort in the short term.