Secondary hyperparathyroidism often occurs as a result of a disruption in calcium and phosphorus homeostasis caused by chronic kidney disease (CKD). While some individuals experience a remission of parathyroid gland disease subsequent to kidney transplantation due to the restoration of calcium homeostasis, a subset continues to exhibit elevated parathyroid hormone due to autonomous secretion, a condition otherwise known as tertiary hyperparathyroidism. This review aims to investigate the intricacies of diagnosis, presentation, medical treatment, state-of-the-art surgical options, and strategies to potentially improve the cure rates of parathyroidectomy in cases of secondary and tertiary hyperparathyroidism.