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INTRODUCTION: Hashimoto's thyroiditis (HT) is the leading cause of hypothyroidism in the United States, treated primarily with thyroid hormone replacement. However, some patients experience physiologic or compressive symptoms despite normalization of thyroid hormone levels, and thyroidectomy may provide relief. This systematic review evaluates the impact on quality of life (QoL) after thyroidectomy in HT patients. METHODS: Search strategies were developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The search was from 2003 to 2024. Relevant terms included the following: HT, hypothyroidism, QoL, thyroidectomy/surgery. Studies were screened by title and abstract by two blinded, independent reviewers, and repeated for full-text articles. Patient characteristics were noted. The primary outcome was change in QoL, either through validated questionnaires or changes in symptoms as a proxy for QoL; symptoms were considered either "compressive" or "physiologic". RESULTS: A total of 2604 abstracts were screened, and 7 (0.3%) studies met inclusion criteria. Briefly, 645 HT patients with persistent symptoms underwent surgery. The majority of patients were female, with an average age of 46-56 y. All had preoperative scores or symptoms indicating poor QoL. Four studies assessed outcomes using the Short Form-36 Health Survey and one study utilized the Thyroid Patient-Reported Outcome questionnaire. The remaining studies did not use validated survey tools to assess QoL, instead assessing symptom improvement during postoperative visits. All studies reported evidence that thyroidectomy has a positive impact on QoL. CONCLUSIONS: There are clear improvements in QoL after thyroidectomy in patients with HT. Patients should be informed that this is a viable treatment option if symptoms persist despite optimized medical management.