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Secondary hyperparathyroidism (SHPT) is a common high-risk factor for mortality in end-stage renal disease, and parathyromatosis and supernumerary parathyroid glands are very rare causes of persistent SHPT. Preoperative diagnosis and removal of all hyperplastic parathyroid glands are challenging. We report a rare case of persistent SHPT due to parathyromatosis and supernumerary parathyroid glands and successful management by multiple imaging modalities. A 53-year-old Chinese woman ondoi:10.1186/s12882-020-01917-3 pmid:32631272 fatcat:vdini6mu4zhbznooe4nvd4w5xy