Background: Surgical removal is one of the most important treatment options for the thyroid swellings. Metabolic derangement due to injury to parathyroid glands is one of the complication to be dealt with frequently. The aim of this study is to assess the incidence of postoperative hypocalcemia after total thyroidectomy and to analyze various pre-operative risk factors that lead to the same. Methods: A retrospective study was conducted on patients who underwent total thyroidectomy at department of ENT and head and neck surgery over a period of 2 years. The level of post-operative serum calcium was analyzed, to determine the incidence of hypocalcemia. In all the patients the following parameters were assessed – age, gender, pre and post-operative serum calcium and type of thyroid disease. Unpaired t test and Mann-Whitney U test was used for statistical analysis. Results: The total study population was 65. The mean age of the patients was 45.5 and 83% of the patients were female. The incidence of postoperative hypocalcemia was noted to be 37%. Pre-operative serum calcium (p<0.0001) was found to be significant risk factor (p<0.05) for prediction of post-operative hypocalcaemia. The same was not noted between variables like age, gender and type of thyroid disease and incidence of hypocalcemia. Conclusions: A thorough knowledge of normal anatomy of neck, possible anatomical variations and parathyroid physiology is of paramount importance to prevent complications during thyroid surgery. Early identification of hypocalcemia can be achieved only by stringent postoperative monitoring, which in turn will reduce morbidity to the patient.