Background: The only cure for primary hyperparathyroidism (1°HPT) is parathyroidectomy. However, many elderly patients are not referred for surgery due to medical comorbidities and/or advanced age. The purpose of this study was to evaluate benefits against risks of parathyroidectomy in this patient population. Materials and methods: From March 2001 to June 2006, 50 patients aged 80 years or older with 1°HPT underwent parathyroidectomy by a single surgeon. Clinical presentation and surgical outcomes of all patients were evaluated. The standard form of the SF-36 Health Survey, designed to measure patient quality of life (QOL), was completed by a subset of patients. Results: There were 45 females and 5 males with a mean age of 83 ± 2 y. Patient comorbidities included hypertension (72%), coronary artery disease (22%), diabetes mellitus (16%), chronic obstructive pulmonary disease (10%), and congestive heart failure (10%). Bone pain was the most common primary presenting symptom (44%), followed by fatigue (12%), confusion (6%), and joint pain (6%). Eleven patients (22%) had ectopic glands. The cure rate postsurgery was 98% (49/50). There were 2 postoperative complications (4%): one patient with transient hypocalcemia and another with cellulitus at an i.v. site. Of patients who completed QOL surveys, greater than 60% reported improved physical functioning, social functioning, and/or mental health, and reduction of bodily pain. Conclusion: Parathyroidectomy is safe and curative for octogenarians and nonagenarians with 1°HPT, and maintains or improves quality of life. The surgical benefits outweigh operative risks, making parathyroid surgery an excellent option for patients over 80 years of age. © 2007 Elsevier Inc. All rights reserved.