Aims: Patients undergoing laryngectomy may be rendered hypothyroid following surgery or due to radiation therapy. Hypothyroidism impairs wound healing which may increase the risk of wound complications or pharyngocutaneous fistula. This study aims to investigate if hypothyroidism is associated with post-laryngectomy wound complications. Methodology: A systematic review and meta-analysis was performed and reported according to the PRISMA guidelines. Pubmed, Embase, Scopus and the Cochrane Library were searched for relevant studies from database inception until August 2023. Qualitative synthesis was performed using chi-square analysis. Meta-analysis was performed using the Mantel-Haenszel method, with sensitivity analyses performed to test the robustness of our results. Results: Sixteen studies included 4,428 patients were identified for inclusion. The mean age was 62.7 years (range 32.0 - 92.0 years), with 80.1% (3,317 / 4,142) being male. In our sample 19.2% (850 / 4,428) were diagnosed with hypothyroidism. Meta-analysis including 12 studies demonstrated an association between hypothyroidism and pharyngocutaneous fistula formation (OR 2.71, 95% CI 1.52 - 4.84, p<0.001). Sensitivity analysis of post-operative hypothyroidism demonstrated an increased risk of PCF formation (OR 3.96, 95% CI 1.94 – 8.07, p < 0.001; I2 34%), while the association was not statistically significant for pre- and per-operative hypothyroidism. Additionally, hypothyroidism was also associated with increased overall wound complications following laryngectomy (OR 2.90, 95% CI 1.36 – 6.19, p=0.006). Conclusions: Hypothyroidism is associated with an increased risk of developing post-laryngectomy wound complications. This supports routine evaluation of thyroid status in patients undergoing laryngectomy and protocols to manage peri-operative hypothyroidism.