Extopic parathyroid glands and rudimentary glands which are not detected during initial parathyroidectomy may develop hyperplasia in the future, causing recurrence of hyperthyroidism. We have devised an improved surgical strategy to prevent the recurrence of hyperparathyroidism. The strategy is to dissect all central lymph nodes and fatty tissue according to the procedure of the dissection of thyroid cancer. The upper level of the dissection area is the upper edge of the thyroid cartilage and the lateral level of the dissection includes the lateral edge of the bilateral carotid sheath. Bilateral transcervical thymectomy is always included in this strategy. Upon confirming that more than 4 glands have been removed by intraoperative stamp cytology, total parathyroidectomy is terminated and 80 mg of glands is autotransplanted to the muscle of one forearm. We have performed this operation on 30 patients since 1987. More than 4 glands could be extirpated in every case, and supernumerary glands were detected in 6 cases (7 glands in 1 case and 5 glands in 4 cases). We have had no operative side effects in this series of 30 patients, and we have not experienced any persistent or recurrent hyperparathyroidism after any of these operations.