Primary hyperparathyroidism (PHPT) is the third most common endocrine disease after diabetes and osteoporosis. It is more common in women and its prevalence increases with age. PHPT is associated with parathyroid adenoma or cancer or paraneoplastic parathyroid hormone (PTH) production. PHPT can be asymptomatic or present with nephrolithiasis, peptic ulcers, pancreatitis, bone lesions and rarely – as a palpable formation in the cervical area. We present a 73-year-old female patient with cystic cervical lesion with high levels of PTH in the evacuated fluid contents. We discuss the differential diagnosis and the diagnostic algorhythm in cystic cervical lesions.