CASE PRESENTATION: An 80 year-old African American female with no past medical or surgical history presented with 4 days of lower abdominal pain and urinary frequency. She was afebrile with vitals within normal limits, however did have a hypercalcemia of 18.5 mg/dL and creatinine of 1.8 on admission. Her magnesium, phosphorus, and potassium were 1.2 mg/dL, 3.9 mg/dL, and 3.5 mEq/L. Intact PTH level was found to be elevated at 1,213 pg/mL. Admission EKG demonstrated some QT shortening and thus the patient was admitted to the medical service under telemetry. She was provided with IV fluid resuscitation and electrolyte repletion with subsequent improvement of her renal function. Thyroid ultrasound demonstrated multinodular goiter and a questionably enlarged right parathyroid gland. A follow up nuclear medicine parathyroid scan demonstrated activity in the right superior mediastinum representing ectopic parathyroid gland. Subsequent CT scan of the chest demonstrated 3 cm posterior mediastinal soft tissue mass. Patient had uneventful VATS excision of the posterior mediastinal mass through three 5 mm ports. Intraoperative PTH level was 3,993 at the beginning of surgery and dropped to 343 15 minutes after removal of the mass. Chesttube was removed the next day and patient was discharged several days later.