The present study aims to investigate the therapeutic efficacy and safety of the combined use of MaiLuoShuTong pills and dalteparin in managing post-operative hypoparathyroidism following total thyroidectomy. Data from 928 thyroid cancer patients who underwent total thyroidectomy and lymph node dissection at the Department of Breast and Thyroid Surgery, Zibo Central Hospital, between May 2021 and October 2022, were retrospectively analyzed. Among these patients, 261 experienced post-operative decreased parathyroid function. Of these, 151 patients (anticoagulant group) received MaiLuoShuTong pills combined with dalteparin anticoagulant therapy and calcium supplementation starting on post-operative day 1. The remaining 110 patients (control group) received only post-operative calcium supplementation. The incidence of permanent hypoparathyroidism, the average time to normalization of parathyroid function, and the average post-operative days until Hemovac removal and total drainage volume were recorded. Treatment efficacy, as well as serum parathyroid hormone (PTH) and calcium levels were compared between the two groups. The anticoagulant group had a 0% incidence of permanent hypoparathyroidism, which was significantly lower than the 3.64% incidence in the control group (P < 0.05). There were no significant differences in the number of post-operative days until Hemovac removal (P = 0.28) or total drainage volume (P = 0.59) between the two groups. Parathyroid function in the anticoagulant group recovered significantly faster at 15, 30, 90, and 180 days compared to the control group (P < 0.05). Post-operative hypoparathyroidism is a common complication after total thyroidectomy. The combined use of MaiLuoShuTong pills and dalteparin anticoagulant therapy can promote parathyroid function recovery, improve PTH and serum calcium levels, enhance clinical efficacy, reduce the incidence of permanent functional impairment, and ensure a safe and reliable post-operative treatment outcome.