Background: The hyperplastic patterns of parathyroid glands (PTGs) in secondary hyperparathyroidism (SHPT) are critical for surgical indication and deciding on the approach. Earlier histopathological investigations have suggested the occurrence of an initial increase in the parathyroid cells, with a normal lobular structure (diffuse hyperplasia, DH). After this, the PTGs become hyperplastic with some nodules (nodular hyperplasia, NH). The current study aimed to explore the relationship between the intraoperative measurements of weight, volume, and maximal diameter of dissected PTGs and the histopathological diagnosis of SHPT patients with end-stage renal disease. Methods: A total of 182 SHPT patients who received parathyroidectomy (PTX) were retrospectively enrolled. Altogether 21 patients were selected as having at least one diffuse polyclonal hyperplasia PTG. Intraoperative measurements of weight, volume, and maximal diameter of dissected PTGs were compared between tissues with DH and NH. Results: Intraoperative dissected PTGs were verified histologically. The differences in the intraoperative measurements of weight, volume, maximal diameter, and the combination of the three measurements between the DH and the NH PTGs groups were significant (P=0.000), and the values of area under the ROC curve (AUCs) were 0.824 (95% CI: 0.731-0.918), 0.812 (95% CI: 0.716-0.908), 0.746 (95% CI: 0.633-0.860), and 0.851 (95% CI: 0.768-0.935), respectively, with cut-off values of the three parameters being 0.19 g, 206.3 mm(3), and 10.5 mm, respectively. Conclusions: The measurement of weight, volume, and maximal diameter of dissected PTGs is a possible alternative to assess the hyperplasia patterns of the dissected PTGs. It is a promising reference for the ultrasound prediction of pathological patterns of PTGs.