Mortality patterns in cetaceans are critical to understanding population health. Common bottlenose dolphins (Tursiops truncatus truncatus) inhabiting the Indian River Lagoon (IRL), Florida have been subjected to four unusual mortality events (UMEs), highlighting the need to evaluate morbidity and mortality patterns. Complete gross examinations were conducted on 392 stranded dolphins and histopathological analyses were conducted for 178 animals (2002–2020). The probable causes of mortality were grouped by etiologic category: degenerative, metabolic, nutritional, inflammatory (infectious and noninfectious disease), and trauma. Probable cause of mortality was determined in 57% (223/392) of cases. Inflammatory disease (infectious/noninfectious) and trauma were the most common. Inflammatory disease accounted for 41% of cases (91/223), with the lungs (pneumonia) most commonly affected. Trauma accounted for 36% of strandings (80/223). The majority of trauma cases were due to anthropogenic activities (entanglement, fishing gear or other debris ingestion, and propeller strikes), accounting for 58% of trauma cases (46/80). Natural trauma (prey-associated esophageal obstruction or asphyxiation, shark bites, and stingray interactions) accounted for 12% of all cases (26/223), and trauma of undetermined origin was identified in 4% of cases (8/223). Starvation or inanition (nutritional) were the probable cause of mortality in 17% of cases and peaked during the 2013 UME (61% of cases). Degenerative and metabolic etiologies accounted for 5% of cases. This study represents the most comprehensive evaluation of morbidity and mortality patterns in IRL dolphins. Because IRL dolphins are routinely exposed to anthropogenic threats and have endured multiple UMEs, these baseline data are critical to the conservation and management of this population.