High-resolution sonography is a significant imaging tool available for evaluation of the parathyroid glands. It works particularly well in concert with nuclear imaging, especially in assisting preoperative localization of parathyroid lesions and in guiding interventional parathyroid procedures. Its limitations relate to anatomic areas not accessible to insonation. In the hands of an experienced examiner, it is a cost-efficient and important adjunct for the endocrine surgeon.