Abstract: 【Abstract】Secondary hyperparathyroidism (SHPT) is one of the major complications in chronic renal failure patients, and seriously affects their prognosis. Parathyroidectomy (PTX) is necessary when serious SHPT is refractory to medical treatment. PTX can effectively ameliorate the signs and symptoms of SHPT, survival rate and the quality of life. Pre-operative imaging, surgical modality and thymectomy are the key factors influencing the postoperative recurrence. According to current literature and our own experiences, preoperative imaging for localization is occasionally helpful to reduce postoperative recurrence. Operative approaches include subtoatal PTX, total PTX with autotransplantation and PTX without autotransplantation. Although there is no strong evidence to prove which operation is the best, we think total PTX is the first choice. Total PTX can effectively reduce postoperative recurrence. Delayed parathyroid autotransplantation may be necessary to avoid complications. Thymectomy is effective in the cases that four glands are not identified and removed.

Key words: Secondary hyperparathyroidism, Parathyroidectomy, Recurrence, Thymectomy