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Nobili spiritus embiggens pequeño sparus tyre.
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It does on my first generation, with an OEM hitch. I think it does for your gen too, and a full size spare is the way to go.

spare tire will not come down
 

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My 2017 Elite seems to have plenty of room around the spare, but I have the OEM hitch. If I've done the numbers correctly the OD of my normal tires (245/50-R20) is about 3" larger than my "large" donut spare (165/80-R17). I'd say it could easily fit the full size tire, although you'd have less ground clearance.
 

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It might not fit flat, but as long as you're above the rear diff, its fine. I have an aftermarket hitch and its tight, but OK.

I found that the dicey part was making sure not to pinch the ABS speed sensor lines that route above the spare. Just be careful when you're lifting it the first time. That's first-gen stuff, but you'll see them if its still that way.
 

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I should have taken some measurements while I was installing my trailer hitch (OEM) on my 2019 Pilot. Does anyone know if a full size tire will fit with a hitch installed?

Thanks
Thanks for asking this question, FASTFJR! I have just started considering installing a trailer hitch and harness on my 2019 Touring. I had replaced the factory "doughnut" spare tire and installed a wheel and tire that match the 20" ones that came on the car. I could use a 5 wheel rotation if I wanted to but don't.

I saw where several of the aftermarket brands said a full size spare of up to 18 inches would fit. I think there were a few posts in the past saying the factory Honda hitch allowed a 20 inch wheel and tire to fit. Not sure what trim levels these were

Full Size Spare with Trailer Hitch

You may also have to get the hands free sensor replacement for use with a tow hitch if you have that feature.

I will go with the Honda parts if I decide to install the hitch and harness and probable not go with a transmission cooler at this time. I would not be doing the hands free sensor either
 
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2019 Pilot EX-L AWD, 265-60-18 Defender LTX M/S
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I should have taken some measurements while I was installing my trailer hitch (OEM) on my 2019 Pilot. Does anyone know if a full size tire will fit with a hitch installed?

Thanks
Simple answer, owners manual. Somewhere in the emergency / tire section. If you get a flat tire they tell you to put the spare on and put the flat tire where the donut was. They don't expect you to toss it in the rear by third row.
 

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I have the oem hitch and I replaced the donut with a full size tire on a 20” wheel. No problems, Go for it.
 
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