Hyperparathyroidism can induce fatal complications in long-term hemodialysis patients. Approximately 20% of patients with hyperparathyroidism have ectopic mediastinal parathyroid glands, and the locations of 2% require a median sternotomy or thoracotomy. A 68-year-old man with an ectopic parathyroid gland in the thymus, underwent total resection via a video-assisted mediastinoscopic approach, which provides a less invasive surgical approach.