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In all pediatric PHPT patients, surgical resection of the parathyroid gland is required for definitive treatment. In a previous study, the authors reported that ectopic parathyroid adenoma accounts for 6%–16% of total parathyroid adenomas, and the most common ectopic location is the thymus, which accounts for 38% of ectopic parathyroid adenomas. PHPT is caused by a solitary parathyroid adenoma in 80% of diagnosed adults and 65%–70% of children.

Pediatric PHPT may occur due to genetic causes, such as familial hypocalciuric hypercalcemia (FHH), familial isolated hyperparathyroidism, and multiple endocrine neoplasia (MEN). In contrast, PHPT cases are rare in children and are likely to account for <5% of the cases of hypercalcemia in children. Parathyroid carcinoma occurs rarely, accounting for <1% of all cases of PHPT. Primary hyperparathyroidism (PHPT) accounts for > 90% of hypercalcemia in adults, and most patients with PHPT present with a single adenoma (80%) or hyperplasia (15%–20%) of the parathyroid gland. The causes of hypercalcemia in children can be classified as parathyroid hormone (PTH)-dependent or PTH-independent and may be either congenital or acquired. Hypercalcemia is uncommon in children patients typically present with characteristic signs/symptoms or may be diagnosed incidentally following investigations for a variety of nonspecific conditions. Keywords: Primary hyperparathyroidism, Hypercalcemia, Ectopic parathyroid gland, Parathyroid adenoma, Child If ectopic parathyroid adenomas are well localized in preoperative imaging evaluation and intraoperative iPTH level decreases after resection, ectopic parathyroidectomy without bilateral neck exploration may be performed to avoid unnecessary morbidity. Delayed diagnosis of PHPT can cause end-organ damage a timely diagnosis is especially critical to preserve bone and renal function. Intact parathyroid hormone (iPTH) and alkaline phosphatase levels returned to normal ranges within 3 months. After surgery, the patient’s serum calcium level immediately normalized. Pathology showed intrathymic ectopic parathyroid adenoma. Video-assisted thoracoscopic surgery was performed to remove the ectopic parathyroid adenoma. Neck ultrasonography and Tc-99m-sestamibi (MIBI) scanning with single-photon emission computed tomography/computed tomography (SPECT/CT) revealed ectopic parathyroid adenoma in the thymus. We report the case of a 15-year-old boy with PHPT due to an intrathymic ectopic parathyroid adenoma. Ectopic parathyroid adenomas account for 6%–16% of all parathyroid adenomas and are rare in children but should be considered in cases that present with hypercalcemia. PHPT is typically caused by a single parathyroid adenoma. Long term use of Lithium (a psychiatric drug) may increase the risk of developing hyperplasia.Hypercalcemia due to primary hyperparathyroidism (PHPT) is uncommon in children. With hyperplasia all four parathyroid glands grow larger, but an adenoma does not grow inside the glands. Parathyroid hyperplasia is a different condition than hyperparathyroidism. Radiation exposure from nuclear power plant accidents or other sources.A childhood history of radiation treatments for acne or other condition in the head and neck area (common in the 1940s to 1950s).