Persistent hyperparathyroidism caused by incomplete parathyroid resection and a hyperfunctioning parathyroid autograft

A case of familial primary hyperparathyroidism occurred in which persistent hypercalcemia was caused by hyperplastic parathyroid tissue left in the neck and mediastinum after initial surgery and by a hyperfunctioning parathyroid autograft in the forearm. Successful therapy required parathyroid localization and resection of tissue from the neck, mediastinum, and forearm. Parathyroid tissue should be autotransplanted at the time of initial surgery only when total parathyroidectomy is judged likely to have been achieved.