A 70-year-old woman presented with pressure symptoms from a goiter. On workup her parathormone levels were elevated. She had undergone neck exploration 10 years previously for hyperparathyroidism, at which time a left inferior and part of a right superior gland were removed. Parathormone levels never returned to normal levels after the first surgery. Further workup revealed osteopenia and nephrolithiasis. Parathormone at the time of this admission was 248. Sestamibi scan showed a hot spot in the mediastinum.