Background and objective <p>The most prevalent complication following total thyroidectomy is hypoparathyroidism. Permanent hypoparathyroidism poses a significant medical burden, necessitating lifelong medication and regular follow-up. Parathyroid transplantation has demonstrated its biological efficacy and is therefore widely utilized in total thyroidectomy procedures. However, the mechanisms and treatment approaches vary considerably, lacking standardized guidelines.</p> Methods <p>We conducted a narrative review of relevant literature on PubMed using the keywords “Parathyroid gland, transplantation, autotransplantation, allotransplantation, hypoparathyroidism, total thyroidectomy” to elucidate the surgical management and future prospects for permanent postoperative hypoparathyroidism (PPH).</p> Key content and findings <p>Preservation of the parathyroid gland blood supply and prevention of inadvertent parathyroid removal during thyroid surgery, performed by a skilled surgeon, are crucial for preventing PPH. Parathyroid autotransplantation (PAT) during thyroidectomy significantly reduces the occurrence of PPH. For established PPH, alternative techniques include transplantation of autologous cryopreserved parathyroid tissue (PT) and parathyroid allotransplantation.</p> Conclusions <p>Current management of PPH primarily encompass high-dose vitamin D and calcium supplementation, parathyroid hormone (PTH) replacement therapy, and autologous or allogeneic transplantation of parathyroid. Ongoing research is expanding the therapeutic landscape to include novel approaches such as stem cell-derived therapies and recombinant human PTH (rhPTH) replacement.</p>