Objective To compare the clinical efficacy and incision aesthetics of transaxillary endoscopic thyroid surgery and traditional anterior cervical open surgery. Methods A total of 80 patients who underwent thyroid surgery in the Department of Thyroid and Breast Surgery, the First People’s Hospital of Chuzhou from January to December 2022 were randomly divided into observation group and control group, with 40 patients in each group. The observation group underwent transaxillary endoscopic thyroid surgery, and the control group underwent traditional open surgery. The clinical indicators, clinical efficacy, incision aesthetics, complications and satisfaction were compared between the two groups. Results The intraoperative blood loss, postoperative 24 h drainage volume and postoperative hospital stay in the observation group were better than those in the control group, but the operation time was longer than that in the control group ( P <0.05). The total effective rate of the observation group was higher than that of the control group ( P <0.05). The cosmetic effect of incision in the observation group was better than that in the control group, and the patient satisfaction was higher than that in the control group ( P <0.05). Conclusion Compared with traditional anterior cervical open surgery, the clinical efficacy and incision aesthetics of transaxillary endoscopic thyroid surgery are more ideal, and the patient satisfaction is higher, which is conducive to promoting the rapid recovery of patients.