Thyroid enlargement causes anatomical complications, such as restricted neck movement and distorted laryngeal anatomy, making airway management challenging in patients. This randomized, prospective study aimed to assess the efficacy of the Macintosh laryngoscope versus the Airtraq video laryngoscope for endotracheal intubation in patients with thyroid enlargement. Around 80 adults rated as I or II by the American Society of Anesthesiologists ASA were randomly selected and split into 2 groups of 40. Both methods utilized a flexometallic tube to intubate the trachea following induction of general anesthesia. Postoperative airway symptoms, intubation time, Cormack-Lehane score, Percentage of Glottic Opening (POGO) score, Intubation Difficulty Score (IDS), and hemodynamic changes during and after intubation were recorded. Airtraq took longer than Macintosh to intubate patients on average; P=0.003. While the Airtraq group had higher POGO, IDS, and Cormack-Lehane scores, the Airflow group had higher IDS and Cormack-Lehane scores. The hematic variations between the groups were similar. The need for an optimization maneuver and the severity of postoperative airway symptoms were higher in the Macintosh group. Airtraq video laryngoscope provides better visualization of the glottis, less manipulation during intubation, and fewer post-operative complications than Macintosh laryngoscope in patients with thyroid swelling, but intubation takes much longer with the former.