<p>This study aimed to evaluate whether mitoxantrone hydrochloride injection (MHI) provides lymph node tracing and parathyroid preservation outcomes comparable to those of carbon nanoparticle suspension injection (CNP) during robotic thyroidectomy for papillary thyroid carcinoma (PTC). We conducted a retrospective review of 507 patients with PTC who underwent robotic thyroidectomy from September 2024 to September 2025. Patients were categorized into CNP and MHI groups based on the tracer utilized. After 1:1 propensity score matching, 62 matched pairs were selected for the final analysis. The primary outcomes encompassed the counts of dissected, metastatic, and stained lymph nodes, along with outcomes related to parathyroid preservation. Secondary outcomes included perioperative parameters and postoperative complications. After matching, the baseline characteristics of the two groups were well balanced. There were no notable differences in the counts of total lymph nodes, metastatic lymph nodes, stained level VI lymph nodes, parathyroid autotransplantation, incidental parathyroid resection, or intraoperative parathyroid identification. Preoperative, postoperative day 1, and 6-month postoperative serum calcium and parathyroid hormone (PTH) levels were comparable between the groups. Surgical recovery indicators and postoperative complication rates were also similar between the groups. In this single-center, propensity score-matched retrospective study, MHI showed efficacy and safety similar to those of CNP in lymph node tracing and parathyroid preservation. These findings suggest that MHI may be a practical alternative tracer in robotic thyroid cancer surgery.</p>