Recurrent Hyperparathyroidism Following Successful Four-Gland Parathyroidectomy and Normalization of Parathyroid Hormone in a Renal Transplant Patient

Chronic kidney disease has an estimated prevalence of 10% in Australia and is predicted to rise in the coming years. Secondary hyperparathyroidism resulting from chronic kidney disease is an important cause of morbidity in these patients; and screening for secondary hyperparathyroidism is recommended in international guidelines. We present the case of a chronic kidney disease patient who developed recurrent hyperparathyroidism despite previous “total” parathyroidectomy and subsequent renal transplant. After targeted investigations he was diagnosed with an accessory parathyroid gland in his thorax, causing the recurrent hyperparathyroidism. He was managed with a thoracoscopic excision with a resultant drop in parathyroid hormone consistent with surgical cure. This case highlights the rare phenomenon of supernumerary and ectopic parathyroid glands. Cross sectional thoracic imaging can and should be used to detect and localize supernumerary glands not apparent at the time of original surgery.