【Abstract】Objective To compare the efficacy of total parathyroidectomy with forearm-autotransplantation (tPTx + AT) and subtotal parathyroidectomy (sPTx) in patients with secondary hyperparathyroidism (SHPT). Methods We retrospectively analyzed the clinical data of 284 SHPT patients accepted the surgery in our hospital from 2004 to 2018. Preoperative and post-operative serum calcium and PTH were analyzed, and their complication rate and recurrence rate were discussed. Results Postoperative serum calcium (t=11.340, P＜0.001 for tPTx+AT; t= 8.209, P＜0.001 for sPTx) and PTH (t=69.968, P＜0.001 for tPTx+AT; t=67.973, P＜0.001 for sPTx) were significantly lower than those before operation in both groups. Postoperative serum calcium had no difference between the two groups (t=0.491, P=0.636). Serum PTH level after operation for 6 months was statistical different between the two groups (t=2.412, P=0.023). The recurrence rate was 27.3% in sPTx group and was 9.92% in tPTx+AT group (χ2=6.110, P=0.013). Conclusion Both tPTx+AT and sPTx have a significant short-term effect on SHPT. tPTx+AT is more conducive to reduce PTH and lower recurrence rate than sPTx. Severe complications are rare, but recurrence of SHPT is still present in some cases.