Background: Our aim was to examine the outcomes of patients with tertiary hyperparathyroidism (3-HPT) who had limited resection of 1 or 2 parathyroids. Methods: We reviewed 140 patients with 3-HPT who underwent parathyroidectomy (PTX) at a single institution. Patients were analyzed according to their operation-limited PTX versus subtotal or total PTX. Results: The limited PTX group consisted of 29 patients who underwent resection of 1 (n = 12) or 2 (n = 17) parathyroids. The other 111 patients had subtotal (n = 104), total (n = 3), and/or reoperative PTX (n = 12). The mean ± SEM follow-up was 79 ± 5 months. Eucalcemia was achieved in 94% of the patients. All patients with persistent (n = 2) hypercalcemia underwent subtotal PTX (P = not significant [NS] vs limited PTX). In a logistic regression model, the extent of operation was not associated with the development of recurrent disease. Additionally, the incidence of permanent hypocalcemia was 7% after subtotal or total PTX versus 0% after limited resection (P = NS). Conclusion: Long-term outcomes in patients with 3-HPT appear to be similar after appropriate limited resection of 1 or 2 parathyroid glands compared to subtotal or total PTX. Therefore, a strategy of limited parathyroid resection seems appropriate for patients with 3-HPT when the disease is limited to 1 or 2 glands. © 2009 Mosby, Inc. All rights reserved.