After the second operation, positron emission tomography (PET), CT neck and sestamibi failed to identify the tumor but a sequence of SVS PTH and four-dimensional computed tomography (4DCT) successfully identified several ectopic adenomas.<h4>Discussion</h4>Ectopic parathyroid tissue is the most common cause of recurrent hyperparathyroidism but precisely locating these ectopic glands is often challenging. This evidence concerns the gene PTH and hyperparathyroidism.