Clinical presentation: A 71-year-old woman was referred for aspiration cytology because of a nodular goiter disclosed on a carotid Doppler examination.

Ultrasonography revealed a hypoechogenic lesion dorsal to the upper pole of the lower part of the left thyroid.

FNAC: a benign lesion.

Combined sonographic-cytologic diagnosis possible parathyroid adenoma.

Scintigraphy disclosed a parathyroid enlargement in this localization, while serum-calcium and parathormone level were elevated.

Histopathology: a solitary parathyroid adenoma.

Comment: This is one of our few cases of a hyperfunctioning parathyroid adenoma causing hypercalcemia in which the evaluation process was initiated by ultrasonography.