Recurrent primary hyperparathyroidism: A diagnostic challenge in a supernumerary intrathyroidal dormant adenoma

Introduction: Recurrent primary hyperparathyroidism is a rare entity and presents a significant surgical challenge. Presentation of case: We present the case of a 53-year-old female with recurrent primary hyperparathyroidism, which was caused by the very rare occurrence of a metachronous parathyroid adenoma in a supernumerary intrathyroidal parathyroid. Discussion: This unique case highlights the challenges that arise in the evaluation of recurrent hyperparathyroidism in which even a thorough preoperative evaluation including radiographic, nuclear medicine studies and fine needle aspiration cytology did not facilitate a definitive preoperative diagnosis. Conclusion: The management approach for these patients requires meticulous planning, experience and appropriate use of intraoperative adjuncts to guide surgical strategy.