We report on a 55-year-old woman with suspected primary hyperparathyroidism who underwent dual phase Tc-99m sestamibi parathyroid imaging. Symmetric, patchy activity in the neck and shoulders was localized to low attenuation areas on integrated SPECT/CT and attributed to uptake in brown adipose tissue (BAT). Focal uptake in the anterior thorax on SPECT images, which potentially may have been misinterpreted as ectopic parathyroid tissue, was demonstrated on SPECT/CT as uptake in BAT. Recognition of this pattern on parathyroid SPECT/CT scintigraphy may avoid false positive reports. Our case provides further evidence that in addition to F-18 FDG, I-123 MIBG, and Tc-99m tetrofosmin, Tc-99m sestamibi may also accumulate in BAT.