Background and Objectives: The management of the thyroid gland during total laryngectomy for advanced laryngeal carcinoma remains controversial. Due to inconsistent reports on invasion prevalence and a lack of clear consensus, prophylactic thyroidectomy is often performed, potentially leading to surgical overtreatment and increased morbidity. This study aimed to determine the frequency of histopathological thyroid invasion and identify independent predictors to refine surgical indications. Methods: We conducted a cross-sectional analytical study of 139 patients undergoing total laryngectomy with thyroidectomy between 2020 and 2025 at Cipto Mangunkusumo General Hospital, Jakarta. Bivariate analyses were performed to identify candidate predictors, followed by multivariate logistic regression to determine independent risk factors for histopathologically confirmed thyroid invasion. Results: Thyroid invasion was histopathologically confirmed in 18% (25/139) of cases. While bivariate analysis associated thyroid involvement with T stage, thyroid cartilage invasion, and various clinical intervals, multivariate logistic regression identified two robust independent predictors; Tracheostomy-to-laryngectomy interval >2 months (aOR 7.40, 95% CI 1.2 – 44.1, p=0.028) and radiologic evidence of thyroid invasion (aOR 55.3, 95% CI 14.3 – 212.9, p<0.001) Notably, 82% of patients underwent thyroidectomy without evidence of pathologic invasion Conclusions: The high rate of pathologically negative thyroidectomies (82%) suggests that routine excision represents significant overtreatment in this population. Radiologic findings and the duration of the tracheostomy-to-laryngectomy interval are critical indicators of thyroid involvement. These results support the implementation of selective, evidence-based criteria for thyroidectomy, offering a pathway to preserve endocrine function and reduce unnecessary surgical complications in advanced laryngeal cancer management.