This 36 y/o male patient with minimally elevated calcium and mildly elevated parathormone level was referred for radioisotope parathyroid imaging. Images from the Tc99m sestamibi scan are shown above. A parathyroid adenoma in the lower pole of the right lobe of the thyroid was suspected and the patient underwent surgical exploration. Frozen sections at the time of surgery showed a papillary carcinoma of the thyroid. Examination of the thyroidectomy specimen demonstrated a focal 1 cm. papillary carcinoma of the thyroid in the right lower pole with foci of papillary carcinoma seen in other sections of the thyroid. Post operatively the parathormone levels have remained elevated and further evaluation to search for the parathyroid adenoma is planned.