Aims: In 2022, thyroid cancer was the seventh most common cancer globally, with most cases occurring in Asia. Advanced stages are associated with poorer survival, and surgery remains the primary treatment. However, in unresectable cases, targeted systemic therapies may be required. Recent studies have shown promising results with lenvatinib as a neoadjuvant therapy, facilitating tumor shrinkage and potential surgical resection in advanced thyroid cancer. This study aims to assess the efficacy and safety of lenvatinib as neoadjuvant therapy in advanced thyroid cancer. Methodology: A systematic review was conducted in PubMed, Scopus, Cochrane, and Science Direct databases up to 24 August 2025 and following PRISMA guidelines. Eligible studies included reports of lenvatinib used as neoadjuvant therapy. Quality was assessed using the Joanna Briggs Institute checklist. Results: Fifteen studies with 71 patients were included (ATC n=39, PDTC n=4, PTC n=26, FTC n=1, MTC n=1). Lenvatinib induced significant tumor shrinkage in most patients, with overall response varies from complete response to progressive disease. Adverse events were frequent, with most toxicities were manageable with dose modification, though some required discontinuation. Conclusion: Lenvatinib shows promise as neoadjuvant therapy in advanced thyroid cancer by reducing tumor burden and facilitating surgery. Large randomized trials are needed to confirm long-term outcomes.