Objective: To compare the clinical characteristics of patients with thyroid cancer undergoing open, endoscopic, and robotic surgery, and to explore the related risk factors for postoperative permanent hypoparathyroidism (PPHP) in these patients. Methods: Clinical data of 1,636 thyroid cancer patients were collected. Patients were divided into three groups according to the surgical approach: open surgery group (n=1,154), endoscopic surgery group (n=226), and robotic surgery group (n=256). Patient characteristics were summarized, and differences between patients with and without postoperative PPHP were compared. Univariate and multivariate Logistic regression analyses were performed to identify risk factors for PPHP. Results: Univariate analysis indicated that whether reoperation was performed, surgical approach, surgical procedure, and lymph node surgery procedure were associated with PPHP (P<0.05). Multivariate analysis showed that whether reoperation was performed and the surgical procedure were associated with the occurrence of PPHP after thyroid cancer surgery (P < 0.05). The incidence rates of PPHP in the endoscopic and robotic surgery groups (0% and 0.39%, respectively) were both lower than that in the open surgery group (2.94%) (P<0.05). Conclusion: Clinicians should fully assess surgical risks during thyroid cancer operations, strive to avoid reoperations, and select appropriate surgical procedures to reduce the risk of PPHP.