Background A desirable combination of smooth extubation, even with prolonged extubation, and an easy maneuver to apply is difficult to achieve. This study aimed to evaluate the efficacy of 0.5% topical bupivacaine for reducing cough, postoperative sore throat, and hemodynamic fluctuations during extubation in patients undergoing thyroidectomy. Methods Forty-eight patients scheduled for thyroidectomy were randomly assigned to two equal groups (24 each): group (C) patients received 5 ml of 0.9% normal saline topically, and group (B) patients received 5 ml of 0.5% bupivacaine topically 15 min, around the tracheal tube, before the expected end of surgery, followed by manual ventilation to obtain air bubbles distributed throughout the entire airway mucosa. The primary outcomes were the incidence and grade of cough. The secondary outcomes were the incidence and degree of postoperative sore throat, extubation time, hemodynamic changes during extubation, and side effects. Results There was a statistically significant decrease in the incidence and the severity of cough in the bupivacaine group compared to the control group. Moreover, the severity of sore throat, as assessed by the VAS score, was lower in the bupivacaine group up to 12 hours postoperatively. The hemodynamic parameters significantly increased in the control group in the peri-extubation period compared to the bupivacaine group, with no difference in extubation time or side effects. Conclusion The use of topical bupivacaine around the ETT significantly reduced the incidence and severity of cough and postoperative sore throat with less hemodynamic fluctuations during the periextubation period in patients undergoing thyroidectomy.