Groundwater flow in cold regions containing permafrost accelerates climate-warming-driven thaw and changes thaw patterns. Simulation analyses of groundwater flow and heat transport with freeze/thaw in typical cold-regions terrain with nested flow indicate that early thaw rate is particularly enhanced by flow, the time when adverse environmental impacts of climate-warming-induced permafrost loss may be severest. For the slowest climate-warming rate predicted by the Intergovernmental Panel on Climate Change (IPCC), once significant groundwater flow begins, thick permafrost layers can vanish in several hundred years, but survive over 1,000 years where flow is minimal. Large-scale thaw depends mostly on the balance of heat advection and conduction in the supra-permafrost zone. Surface-water bodies underlain by open taliks allow slow sub-permafrost flow, with lesser influence on regional thaw. Advection dominance over conduction depends on permeability and topography. Groundwater flow around permafrost and flow through permafrost impact thaw differently; the latter enhances early thaw rate. Air-temperature seasonality also increases early thaw. Hydrogeologic heterogeneity and topography strongly affect thaw rates/patterns. Permafrost controls the groundwater/surface-water-geomorphology system; hence, prediction and mitigation of impacts of thaw on ecology, chemical exports and infrastructure require improved hydrogeology/permafrost characterization and understanding