Background: Thyroid carcinoma is the most common endocrine malignancy, and papillary thyroid carcinoma (PTC) is the most common histologic type. Surgery remains the mainstay of therapy, and the two most encountered surgical procedures are total thyroidectomy (TT) and hemithyroidectomy (HT). The choice of surgery is often determined by tumor characteristics, surgeon preference, and institutional practice, each having certain. Objectives: The aim of this study was to assess the complication rates of total thyroidectomy versus Hemithyroidectomy in the treatment of papillary thyroid carcinoma. Methods & Materials: This cross-sectional observational study was conducted in the Department of ENT, Head and Neck Surgery, Anwer Khan Modern Medical College Hospital, Dhaka, Bangladesh from June 2023 to May 2025. Total 120 patients diagnosed with papillary thyroid carcinoma (PTC) were included in this study. Results: The two groups were comparable in baseline demographic and clinical characteristics (p>0.05). The majority of surgeries lasted less than 60 minutes in both groups (70.8%) (p=0.841). Intraoperative hemorrhage occurred in 56.7% of cases, with no statistical difference between TT and HT groups (p=0.711). Postoperatively, pain was the most frequent complication (51.7%), followed by hemorrhage (32.5%). Vocal cord paralysis was significantly higher in the TT group (11.7% vs. 1.7%, p=0.0291), while other complications such as pain, hemorrhage, and voice change showed no significant group differences. Conclusion: Both surgical approaches demonstrated comparable safety profile. However, total thyroidectomy carried a higher risk of vocal cord paralysis. Hemithyroidectomy can therefore be utilized as a safer alternative in well-selected PTC patients.