Elevated homocysteine levels are a known biomarker for cardiovascular disease. Previous studies have reported inconsistent effects of parathyroidectomy on homocysteine levels. This study aimed to investigate the acute effects of parathyroidectomy on homocysteine levels.

A total of 357 dialysis patients who underwent parathyroidectomy for uncontrolled secondary hyperparathyroidism between 2011 and 2022 were included in the analysis. Baseline and postoperative plasma homocysteine levels were assessed.

The median baseline homocysteine level was 19.2 μmol/L, decreasing to 16.1 μmol/L in the early postoperative period ( P < 0.001). Baseline homocysteine levels showed a positive correlation with phosphorus but not with parathyroid hormone levels. The median change in homocysteine levels before and after surgery was −3.0 μmol/L, reflecting a decrease of 16% from baseline. In multivariate analysis, patients with a higher body mass index or a longer duration of dialysis were less likely to experience a drop of more than 20% in homocysteine levels following parathyroidectomy.

Plasma homocysteine levels decrease rapidly after parathyroidectomy. Further research is needed to clarify the relationship between this decrease and the benefits of surgical management.