Objective <p>Hypoparathyroidism and hypocalcemia are common complications following total thyroidectomy (TT). This study aimed to evaluate the risk of post-total thyroidectomy transient hypoparathyroidism and hypocalcemia through a large single-center retrospective analysis.</p> Methods <p>In this retrospective study, consecutive patients underwent total thyroidectomy from May 2021 to September 2022 were included. Postoperative parathyroid hormone (PTH) level and serum calcium levels were evaluated within 24&#xa0;h. Univariate and multivariate analysis were performed for assessing risk factors for developing transient hypoparathyroidism and hypocalcemia after total thyroidectomy.</p> Results <p>A total of 1065 patients undergoing total thyroidectomy who met the inclusion criteria were enrolled in this study. Among the patients, 460 patients (43.2%) developed hypoparathyroidism after surgery, and a total 325 patients (30.5%) developed hypocalcemia. After multivariate analysis, the independent risk factors related to hypoparathyroidism are female (OR = 1.65, <i>p</i> &lt; 0.001), inadvertent parathyroidectomy (OR = 2.26, <i>p</i> = 0.004), non-papillary thyroid microcarcinoma (OR = 1.55, <i>p</i> = 0.003) and capsule invasion (OR = 1.39, <i>p</i> = 0.034). Meanwhile, the independent risk factors related to hypocalcemia are female (OR = 1.94, <i>p</i> &lt; 0.001) and inadvertent parathyroidectomy (OR = 2.01, <i>p</i> = 0.011).</p> Conclusion <p>Transient hypoparathyroidism and hypocalcemia are relatively common complications following total thyroidectomy. Female, inadvertent parathyroid gland excision, papillary thyroid microcarcinoma, and capsular invasion were identified as independent risk factors for hypoparathyroidism and hypocalcemia.</p>