造成腎性高副甲狀腺血症開刀後失敗的原因，通常是因為缺乏足夠的增生組織切除或以前未被發現的異位性副甲狀腺殘留。在此，我們描述一個復發的腎性高副甲狀腺血症病人，她一開始表現為頸部皮下結節。一個49 歲的女性病患過去有紅斑性狼瘡、甲狀腺乳頭狀癌、末期腎病變併有腎性高副甲狀腺血症，為此她陸續接受了增生性副甲狀腺病灶酒精注射、甲狀腺次全切除及副甲狀腺切除，在追蹤期間，儘管積極得使用磷結合劑治療和維生素 D3 補充，病患的副甲狀腺激素、血鈣、血磷仍不斷升高。甲狀腺超音波檢查並未在甲狀腺床的部位發現甲狀腺或副甲狀腺組織。身體檢查顯示在右頸部有明顯的皮下結節，且這在軟組織超音波檢查下呈現高迴音和異質性。Sestamibi 掃描顯示在同一部位有熱點。她接受了頸部結節的切除手術，病理組織學顯示為副甲狀腺增生。結節切除後的兩年追蹤期間，病人未再復發。總之，為了避免經常性高副甲狀腺血症復發，小心且有經驗的副甲狀腺開刀技術是很重要的。另一方面，因為酒精注射會造成組織纖維化，進而增加後續手術的困難度，因此針對腎性高副甲狀腺血症患者，除非是病人無法接受手術，否則通常不建議使用酒精注射治療。除此之外，當我們遇到復發性高副甲狀腺血症時，在手術前須將皮下副甲狀腺病變考慮進去。

Failure of a primary operation to control renal hyperparathyroidism is usually due to inadequate resection of hyperplastic tissue or previous undetected ectopic parathyroid gland. We describe a patient with recurrent
renal hyperparathyroidism, who presented with a subcutaneous neck nodule. A 49-year-old woman had a history of systemic lupus erythematosus,
papillary thyroid carcinoma, and end-stage renal disease with renal hyperparathyroidism,for which she subsequently received percutaneous ethanol infusion therapy to bilateral hyperplastic parathyroid lesions, a subtotal thyroidectomy and parathyroidectomy. Despite aggressive treatment with phosphate binders and vitamin D3 supplements, the levels of intact parathyroid hormone, calcium and phosphorus kept elevating during the follow-up period. Thyroid sonography revealed neither thyroid nor parathyroid tissue in the thyroid bed. Physical examination showed a palpable subcutaneous nodule at the right neck, which was hyperechoic and heterogeneous on soft tissue sonography. Technetium (99mTc) sestamibi scan showed a focal hot spot at the same site. She received complete surgical resection of the neck nodule. Histopathological analysis
showed parathyroid hyperplasia. Two years after removal of the nodule, the patient was well. In conclusion, to avoid recurrent hyperparathyroidism, a meticulous surgical technique is vital to successful parathyroid surgery.On the other hand, alcohol injection is not recommended for renal hyperparathyroidism if the patient can tolerate
operation, because alcohol injection can cause fibrosis which makes further operation difficult in processing. We should also keep subcutaneous parathyroid lesions in mind when we perform neck re-exploration for recurrent hyperparathyroidism.