Open total thyroidectomy is a commonly performed endocrine surgery. Using a standardized protocol for back table and Mayo stand setup can improve surgical efficiency and boost patient safety. The protocol demonstrated in this educational video covers instrument arrangement, specialized equipment preparation, and safety considerations specific to thyroid surgery. The setup includes organization of forceps, specialized bipolar energy devices, clip appliers, nerve monitoring equipment, and self-retaining retractors. Key safety measures include dual towel protection layers, separation of toothed versus smooth instruments, and sharps management. This protocol provides surgical technology students with a comprehensive framework for thyroidectomy setup and reinforces the fundamental principles of patient safety and procedural efficiency.