Background: After a total thyroidectomy (TT), hypoparathyroidism may develop as a result of intraoperative stress, injury to the vasculature supplying the parathyroid glands, or accidental loss of parathyroid tissue during surgery. Depending on the cohort examined, the type of surgery utilized, and the diagnosis of hypoparathyroidism used, the reported incidence of hypothyroidism after thyroidectomy varies greatly.The aim of the current study is topreserve the parathyroid glands during total thyroidectomy operation by microscopic identification of their blood supply so preventing post total thyroidectomy hypocalcemia due to hypoparathyroidism. Patients and methods: This study was conducted at Otorhinolaryngology, Head and Neck Surgery Department of Zagazig University Hospitals. A total of 24 patients prepared for total thyroidectomy were included in this clinical trial. The patients were randomly divided into two groups; Group I included 12 patients who underwent total thyroidectomy with preservation of the parathyroid glands by microscopic identification of the arterial blood vessels of parathyroid glands. Group II (control group) included 12 patients who underwent a traditional total thyroidectomy. Results: As regarding the postoperative hypocalcemia and hypoparathyroidism in our study, there was an increase in their frequency among the traditional total thyroidectomy group (Group II) (25%) in comparison to microscopic dissection group (Group I) (zero). Although that was not statistically significant “due to the small sample size" but we can clearly notice that the use of microscopic identification technique led us to zero postoperative hypocalcemia and hypoparathyroidism. Conclusions: Microscopic identification of the parathyroid feeding blood vessels as a method to preserve parathyroid glands during total thyroidectomy is a safe procedure with low rate of complications and better clinical outcome without exposure of the patient to toxic or allergic material as dye or specific light.