A 44-year-old man developed tertiary hyperparathyroidism secondary to end stage renal failure. Four years prior to the current presentation he underwent total parathyroidectomy (4 glands), with implantation of thinly sliced fragments in his left forearm. He returned three years later with recurrent hyperparathyroidism. Sestamibi scan at that time showed a hot spot at the suprasternal notch, and a mass of functional parathyroid tissue was removed from that location. The parathormone levels remained elevated, and a year later, the patient returned with swelling at the forearm implantation site.