Despite the great progress in surgical techniques, hypoparathyroidism is still one of the most common complications after total thyroidectomy. Either transient or permanent hypoparathyroidism after operation can cause severe hypocalcemia and affect the patient’s quality of life. Therefore, early diagnosis and prediction of hypocalcemia after thyroid surgery are of great clinical significance. Because parathyroid hormone (PTH) is secreted directly by the parathyroid glands, plus its short half-life, PTH can not only reflect the function of the parathyroid glands in real time, but also reflect the significance of rapid intraoperative PTH testing. Perioperative PTH monitoring for thyroid surgery has the advantages of practicability, effectiveness and economic efficiency in clinical practice. However, there are still some controversies and problems about the actual significance of clinical application of PTH monitoring during perioperative period of thyroid surgery at present, which needs to be verified by prospective studies of a large sample size. In conclusion, perioperative PTH monitoring may be helpful for early detection and prediction of the occurrence of hypocalcemia, optimization of clinical management strategies and methods, and appropriately guiding the postoperative calcium supplementation regimen. Here, the author addresses the methods and significance of perioperative PTH monitoring.