Objective To retrospectively analyze the clinical situation of hypocalcemia after parathyroidectomy (PTX) in hemodialysis patients with refractory secondary hyperparathyroidism (SHPT). Methods A total of 117 hemodialyis patients with SHPT (average dialysis age 113.8±50.2 months, and 51.3±10.7 years old) treated with PTX in the recent 10 years were retrospectively analyzed. Changes of serum Calcium (Ca) after PTX were evaluated. The relationship between minimum serum Ca within one month after PTX and the factors including serum intact parathyroid hormone (iPTH), Ca, alkaline phosphatase (ALP) before PTX, the number of parathyroid glands removed, and the pathology of surgical parathyroid samples were analyzed. The symptoms of hypocalcemia and the supplement doses of calcium and active vitamin D (VitD) were recorded. Results Hypocalcemia occurred postoperatively in 72/117 patients (61.5%), and hypocalcemia symptoms were found in 23 of the 72 hypocalcemia patients (31.9%). Postoperative hypocalcemia usually occurred in the second day after PTX. The average serum Ca in the second day after PTX was 1.92±0.38mmol/L. The symptoms of hypocalcemia were fidget, low blood pressure, numbness in the ends of extremities, palpitation, hidrosis, pulmonary edema, seizures, diarrhea, etc. Minimum serum calcium after PTX correlated negatively with the preoperative iPTH level (r = -0.416, P=0.000) and serum Ca (r = -0.756, P=0.001). Most patients were given oral calcium 2.55±1.68g/day and active VitD 1.42±0.75靏/day within a week after PTX to maintain normal serum Ca. Conclusion Hypocalcemia occurs frequently in patients after successful PTX. The risk factors leading to hypocalcemia after PTX are higher serum iPTH level and serum Ca before PTX. Hypocalcemia symptoms vary in patients. Supplement of sufficient Ca and active VitD is helpful for the prevention of hypocalcemia.