Objective To investigate the optimal starting time，safety and effectiveness of shoulder and neck functional rehabilitation exercise for patients undergoing gassless transaxillary endoscopic thyroidectomy（GTET）. Methods 175 patients who underwent GTET were selected by convenient sampling，with 121 patients in 2 test groups（61 patients in the test group 1 and 60 patients in the test group 2） and 54 patients in a control group. The starting time of postoperative shoulder and neck rehabilitation training in the control group，test group 1 and test group 2 were postoperative 7 days，postoperative 48 hours and 2 hours after general anesthesia wakening，respectively. The analysis among 3 groups included the amount of drainage（ml），the retention time of drainage tube （h），the postoperative hospital stay（d），the cases of bleeding，the pain score of incision（neck and armpit） at postoperative day 1 and day 3，the range of shoulder and neck movement and the quality of life. Results There was no statistically significant difference in term of drainage amount，retention time of drainage tube，bleeding cases，hospital stay and pain in neck and incisions at postoperative day 1 and day 3 among the 3 groups（P>0.05）. The motion range of cervical extension，lateral cervical flexion，cervical rotation，shoulder abduction，shoulder adduction，shoulder flexion and shoulder extension among different groups were statistically significant 1 month after surgery（P<0.001）. In term of quality of life（QOL），there were statistically significant differences in aspects of stiffness，pain，numbness of the neck or shoulder，and the impact on leisure and entertainment（P<0.05）. Conclusion Starting shoulder neck rehabilitation exercise 2 hours after awake under anesthesia in patients undergoing GTET would not cause bleeding and affect the comfort，and could safely and effectively improve the early QOL of patients in the early postoperative period.
