15-year-old female with no past medical history who presented to the emergency room with increasing abdominal pain, fatigue and constipation. She was found to have an elevated serum calcium of 15 and PTH level of 269. Subsequent ultrasound studies showed a 1.7cm lesion in the left central compartment of the neck close which was suspicious for a parathyroid adenoma and adjacent thymus. A parathyroid nuclear medicine scan showed abnormal uptake at the inferior thyroid that was suspicious of a left inferior parathyroid adenoma and she was diagnosed with primary hyperparathyroidism. After aggressive hydration and Lasix administration, her symptoms resolved and she was discharged with endocrine surgery follow up as an outpatient. The patient and her family were very concerned over a scar that an open approach would leave. After thorough evaluation of all the imaging it was determined that she would be a good candidate for the robotic transaxillary approach. She was consented for thymectomy and parathyroidectomy given findings on imaging. She underwent surgery without any complications with minimal dissection of the strap muscles given the inferior lesion and no need to examine the contralateral side. The thymus and enlarged left inferior parathyroid were clearly identified, dissected and removed. Her initial PTH level prior to incision was 434. After the culprit lesion was removed, the PTH level fell to 20. Frozen section confirmed thymic tissue and hypercellular parathyroid tissue. She did well post-operatively and had complete resolution of her symptoms.