Objective To compare the clinical effect of endoscopic radical thyroidectomy with non⁃inflat⁃ able axillary approach and transthoracic mammary approach. Methods A total of 168 patients with thyroid cancer admitted to our hospital from January 2019 to February 2022 were divided into study group and control group by random number table method，with 84 cases in each group. The control group received laparoscopic radical thyroid⁃ ectomy via breast and thoracobreast approach，while the study group received the thyroidectomy via inflatable axil⁃ lary approach. The surgical operations and the changes of parathyroid function of the two groups were analyzed. The two groups were compared in terms of postoperative pain，perioperative stress，postoperative complications and patients′ satisfaction with the incision. Results The operation time and postoperative drainage volume in the study group were longer and higher than those in the control group（P < 0.05），but there was no significant difference in the number of lymph node dissection between them（P > 0.05）. There were no significant differences in PTH and serum calcium between them either before and after operation（P > 0.05）. The VAS scores showed significant differences in each group before surgery，1 month after surgery and 3 months after surgery，respectively（P < 0.05）， but no significant differences between the two groups at the three time points（P > 0.05）. There was no significant difference in the varying trend of VAS scores between the two groups（P > 0.05）. The levels of adrenalin（Adr） and cortisol（Cor）were significantly different within each group at the three time points（P < 0.05），but there were no differences in the level of Adr and Cor between the two group at respective time point. There were no significant differences in the varying trends of Adr and Cor scores between the two groups（P > 0.05）. There was no significant difference in total complication rate between the groups（P > 0.05）. The rate of patient′s satisfaction with incisional cosmetics in the study group was significantly higher than that in the control group（P < 0.05）. Conclusion The effect and safety of non⁃inflatable axillary approach are similar to those of transthoracic mammary approach for laparoscopic radical thyroidectomy. Although it takes longer time and has larger postoperative drain⁃ age，the non⁃inflatable axillary approach is better from the perspective of postoperative cosmetic effect.