Primary hyperparathyroidism is defined by increased parathyroid hormone secretion resulting from parathyroid adenoma, hyperplasia, and more rarely from parathyroid malignancy. Parathyroidectomy with neck approach either bilateral neck exploration or focused surgery is the treatment of choice in most of the cases. But primary hyperparathyroidism that is persistent or recurrent can be related with insufficient resection or the development of a second adenoma or malignancy.

Here we present a 51-year-old woman who had a previous failed neck exploration including total thyroidectomy, but then diagnosed with an ectopic parathyroid adenoma in the anterior mediastinum. Parathyroid adenoma in anterior mediastinum was shown with Sestamibi scintigraphy and then confirmed with contrast enhanced computed tomography.

We decided to perform left side videothoracoscopy and exploration of mediastinum due to the localization of suspected adenoma. After the surgical removal the adenoma, PTH levels decreased drastically from 155.2 pg/mL to 18.6pg/mL. The patient is discharged on postoperative day 2 uneventfully.

The prevalance of ectopic parathyroid adenoma of the anterior mediastinum might be higher and reported between 6% and 30%. Minimally invasive thoracic surgical procedures both videothoracoscopic or robotic surgery could be the best option in patients with mediastinal ectopic parathyroid adenomas.