We reviewed the results of twenty-four years' experience of parathyroidectomy for secondary hyperparathyroidism. Over the period from 1976 to 2000, we performed 171 parathyroidectomies for secondary hyperparathyroidism (91 males, 80 females; median age: 57.4). Autotransplantation was performed in 45. Of the 171 patients undergoing parathyroidectomy, 14 (8.1%) were treated for relapse. Twenty-four of the 45 patients treated with autotransplantation (53.3%) were followed up for 82 +/- 37 months. Hypoparathyroidism was observed in 33.3% of these (worse after 6 months in 21% and stable in 46%). Five patients (11.1%) experienced a relapse of hyperparathyroidism. We believe that the treatment of choice for secondary hyperparathyroidism is subtotal parathyroidectomy, the indications for autotransplantation in parathyroid surgery are rare.