Tertiary hyperparathyroidism (THPT) emerges from chronic secondary hyperparathyroidism (SHPT) in patients with longstanding end-stage renal disease (ESRD), often evolving into autonomous parathyroid hormone (PTH) secretion, which persists in approximately 20-30% of cases, despite renal transplantation [1, 2]. This evidence concerns the gene PTH and stage 5 chronic kidney disease.