Objective To explore the significance of mitoxantrone hydrochloride injection and carbon nanoparticles suspension injection in endoscopic radical thyroid cancer surgery. Methods A retrospective analysis was carried out on patients who underwent endoscopic radical surgery for unilateral thyroid cancer at the Department of General Surgery， Gansu Provincial Central Hospital， from December 2022 to February 2024. The patients were classified into two groups according to the intraoperative tracer employed： the mitoxantrone group and the nanocarbon group. After a 6-month postoperative follow-up， the baseline data of the two patient groups were compared. The intraoperative visualization of lymph nodes and parathyroid glands in both groups was observed. Additionally， the hospitalization costs and the incidence of postoperative complications were compared between the two groups. Results In this study， 110 cases were included in the Mitoxantrone group and 126 cases in the nanocarbon group. The staining time of the central lymph nodes was significantly shorter in the nanocarbon group compared to the mitoxantrone group （P < 0.05）. The blue staining rate of MHI reached 97.5%， while the black staining rate of CNSI was 98.3%. The difference between them was not statistically significant （P > 0.05）. Regarding the number of central lymph nodes dissected， it was 9.34 ± 0.22 in the Mitoxantrone group and 9.88 ± 0.24 in the nanocarbon group， with no statistically significant difference （P > 0.05）. Similarly， the parathyroid misdissection rates were 1.8% and 0.8% in the two groups respectively， and no significant statistical difference was observed （P > 0.05）. Postoperative blood calcium and PTH levels measured at 1 day， 1 month， and 6 months did not show any statistically significant differences between the two groups （P > 0.05）. The incidence of transient hypoparathyroidism and hypocalcemia was comparable in both groups （P > 0.05）， and no patients developed permanent hypoparathyroidism or permanent hoarseness. None of the patients in one Mitoxantrone group experienced postoperative hemorrhage， coeliac leakage， or skin staining. In contrast， in the nanocarbon group， there was one case of postoperative hemorrhage and one case of coeliac leakage， and two case of skin staining. Conclusions In laparoscopic unilateral thyroid cancer radical surgery， when it comes to lymph node tracing and parathyroid gland protection， no significant disparities were detected between MHI and CNSI. Nevertheless， CNSI exhibits a shorter staining time for central lymph nodes. In contrast， MHI is more manageable， features a faster metabolic rate， and has been demonstrated to be more cost-effective.