Objective <p>Uremic tumoral calcinosis (UTC) is a relatively rare but challenging complication in dialysis patients, characterized by abnormal calcium salt deposition. Parathyroidectomy (PTX) is a commonly used treatment; however, some patients experience limited postoperative symptom improvement, suggesting potential factors that affect PTX efficacy. This study aims to investigate the mechanisms underlying suboptimal remission of UTC after PTX to optimize treatment strategies and improve patient outcomes.</p> Methods <p>We report a case of a maintenance hemodialysis patient whose UTC worsened after PTX. Following discontinuation of active vitamin D and intensified phosphorus management, the patient’s calcium-phosphorus product significantly decreased, accompanied by marked regression of calcified lesions. To further explore possible mechanisms, we reviewed and analyzed previous literature on PTX treatment for UTC and compared our case with related reports.</p> Results <p>Our findings demonstrate considerable individual variability in PTX efficacy for UTC treatment, with calcium-phosphorus product (Ca×P) levels playing a critical role in patient prognosis. This study suggests that calcium-phosphorus metabolism may be a key factor influencing PTX outcomes.</p> Conclusions <p>This case highlights the importance of controlling the calcium-phosphorus product in treating UTC.Postoperative management should focus on optimizing calcium-phosphorus metabolism, with particular attention to individualized phosphorus control strategies and appropriate use of active vitamin D.These approaches are crucial for enhancing PTX efficacy and improving long-term patient prognosis.</p> Clinical trial number <p>Not applicable.</p>