Objective: To explore the predictive value of qualitative and quantitative techniques of contrast-enhanced ultrasound on evaluating the severity of secondary hyperparathyroidism (SHPT) and the recurrence after microwave ablation. Methods: The clinical data of 75 patients with SHPT treated in our hospital from January 2021 to August 2023 were retrospectively analyzed. After admission, qualitative technique of contrast-enhanced ultrasound was used to assess the perfusion pattern, early and late enhancement, enhancement uniformity, earliest arrival time, peak intensity (PI) and travel time. The patients were divided into mild group (PTH between 250ng/L and 600ng/L), moderate group (PTH between 600ng/L and 800ng/L) and severe group (PTH>800ng/L) according to serum parathyroid hormone (PTH) level. The detection results of qualitative technique of contrast-enhanced ultrasound were compared among the three groups, and ROC curve wad drawn according to the PI detection to analyze the predictive efficiency of qualitative and quantitative techniques of contrast-enhanced ultrasound on recurrence after microwave ablation in patients with SHPT. Results: There were statistically significant differences in perfusion pattern, enhancement uniformity and earliest arrival time among the three groups (P<0.05), but there were no statistical differences in early and late enhancement and travel time (P>0.05). The enhancement uniformity and PI revealed statistical differences between recurrence group and non-recurrence group (P<0.05), but the perfusion pattern, early and late enhancement, travel time and earliest arrival time were not statistically different between the two groups (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of PI value on predicting recurrence in patients with SHPT after microwave ablation was 0.631 (P<0.05). Conclusion: Qualitative technique of contrast-enhanced ultrasound can be used to evaluate the severity of patients with SHPT, and PI value has a high predictive value on the recurrence in patients with SHPT after microwave ablation.