This report details a case of recurrent hyperparathyroidism in a MEN1 patient with supernumerary ectopic parathyroids. She had five parathyroid glands excised over three operations spanning over a decade. Post-operatively, she developed HBS requiring calcium replacement. This highlights the complexity of management in MEN1 syndrome, and reinforces the significant role of clinical, biochemical and radiological review. A 37-year-old female presented with persistent primary hyperparathyroidism on a background of MEN1 syndrome. Ten years prior, she had a neck exploration, three-gland parathyroidectomy (left inferior not identified), thymectomy and reimplantation. She re-presented with hyperparathyroidism with no localising source on sestamibi scintigraphy, CT neck and attempted re-do parathyroidectomy. In a third presentation, 4D CT localised a parathyroid adenoma, which was removed in re-do left parathyroidectomy. In another re-presentation with hyperparathyroidism, 4D CT demonstrated an ectopic parathyroid adenoma at the level of the left common carotid artery, which was removed in another re-do left parathyroidectomy. Post-operatively, she was commenced on 3.6g oral calcium carbonate daily due to symptomatic hypocalcaemia. However, her PTH was elevated at 17. This clinical picture was consistent with HBS. She is on long-term calcium and vitamin D supplementation, with close monitoring of biochemical markers. This case illuminates the complexity of managing recurrent hyperparathyroidism in a patient with MEN1 syndrome. Modern developments in radiology have a significant role in localising ectopic and supernumerary parathyroid glands, and repeat scans are worthwhile. Early detection of HBS enables the initiation of simple management and prevention of complications.