Primary hyperparathyroidism (PHPT) is primarily treated with surgery, achieving a 95% cure rate when performed by skilled surgeons. However, 4–5% of patients experience persistent or recurrent PHPT post-surgery due to factors such as undetected adenomas or misdiagnoses like familial hypocalciuric hypercalcemia (FHH). Despite advancements in intraoperative parathormone monitoring and preoperative imaging, some cases remain challenging due to ectopic gland locations and other factors. This underscores the need for multidisciplinary approaches and thorough preoperative planning to enhance surgical outcomes in PHPT management.