Objective To explore the effect of endoscopic radical thyroidectomy combined with parathyroid autotransplantation on the recovery of postoperative parathyroid function. Methods The clinical data of 323 patients undergoing endoscopic radical resection of thyroid carcinoma in the General Surgery Department of Gansu Provincial People's Hospital from January 2019 to April 2021 were retrospectively analyzed and divided into transplant group (n=171) and non-transplant group(n=152) according to whether combined with selective parathyroid. The incidence of circulating parathyroid hormone (PTH),Ca²⁺ concentration and hypoparathyroidism were recorded before surgery and 1 day, 1 week, 1 month, 3 months, 6 months and 12 months after surgery in both groups, and the PTH concentration in the elbow fossa veins of both arms were collected in the transplant patients. Risk factors for hypoparathyroidism after thyroid surgery were analyzed using logistic regression. Results The incidence of transient hypoparathyroidism was higher, while of permanent hypoparathyroidism was lower in transplant group than in non-transplant group (33.33% vs. 23.03%; 0.58% vs. 5.26%), the differences were significant (P=0.007). The PTH concentrations were significantly higher in transplant group than in non-transplant group from 1 week to 12 months after surgery with statistically significant difference (P<0.001). The PTH concentration in vein of transplant side cubital fossa was significantly higher from 1 week to 12 months after surgery in transplant group than in non-transplant group, and the differences were statistically significant(P<0.001). Twelve months after surgery, PTH secretion function in transplant group and non-transplant group had recovered to 85.42% and 67.60% of preoperative baseline, respectively. Univariate logistic regression analysis showed that transplantation and Hashimoto's thyroiditis were the risk factors for temporary hypoparathyroidism after thyroid surgery (OR=1.671, 95%CI 1.020-2.738,P=0.041; OR=1.925, 95%CI 1.138-3.259, P=0.015), and transplantation was a protective factor for permanent hypoparathyroidism(OR=0.106, 95%CI 0.013-0.857, P=0.035). Multi-factor logistic regression analysis showed that transplantation and Hashimoto's thyroiditis were the risk factors for temporary hypoparathyroidism (OR=1.736, 95%CI 1.044-2.887, P=0.034; OR=1.903, 95%CI 1.111-3.258, P=0.019), and transplantation was a protective factor for permanent hypoparathyroidism (OR=0.101, 95%CI 0.012-0.839, P=0.034). Conclusion In endoscopic radical resection of thyroid carcinoma, parathyroid autotransplantation is an effective strategy to prevent permanent hypoparathyroidism, but can also lead to short-term postoperative hypoparathyroidism. As far as possible, selective transplantation of the inferior pole parathyroid glands with intraoperative damage or poor blood supply, based on in situ preservation of the superior pole parathyroid glands, is more conducive to recovery of postoperative parathyroid function.