Background. Various elective surgical procedures are routinely performed on patients C80 years of age. With primary hyperparathyroidism (PHPT), surgical management is the only treatment. The goal of this study was to compare presentation and outcome of patients C80 to that of those\80 years of age. Methods. Retrospective review of a prospectively collected database of all parathyroidectomies for PHPT performed at a university hospital. Patients C80 years at the time of surgery compared with patients\80 years. Results. Over 13 years, 1,826 patients underwent parathyroidectomy for PHPT. A total of 154 patients were C80 years at the time of surgery (8.4 %), ranging from 80 to 91 years. Patients C80 years had higher serum PTH, creatinine and vitamin D levels and lower T scores. Calcium levels were similar. Patients C80 years had a greater history of hypertension, coronary artery disease, congestive heart failure, and stroke. Psychiatric disease was less common. Patients C80 years had the procedure under local anesthesia only more often. Use of a unilateral approach was equivalent. Rates of adenoma, double adenoma, and hyperplasia were comparable. Patients C80 years were observed overnight more frequently. Stays[24 h and disease recurrence and persistence, as well as morbidity rates, were all equivalent. Conclusion. Disease presentation of PHPT in patients C80 is similar to \80. Despite increased comorbidities, parathyroidectomy is a safe procedure in this patient population with a noted equivalent complication rate to younger patients. Operative management remains the only treatment. Patient age should not be a deterrent to offer curative surgical intervention. © 2013 Society of Surgical Oncology.