Secondary hyperparathyroidism and renal osteodystrophy are major complications of end stage renal failure, resulting from disorders in the regulation of parathormone, calcium, phosphorus, and vitamin D. We present a 16-year old woman as a case of renal osteodystrophy who referred to our hospital because of strong bone pains, growth retardation and walking disability. As a result of resistance to drug treatment in this patient, the radioguided parathyroidectomy was planned; consequently parathyroid and thyroid scintigraphy were done. In thyroid scan with Tc-99m sodium pertechnetate, there was an increased radioactivity uptake in middle line on thoracic region that was thought to be sternum. Then neck scan, images of the thorax, abdomen and pelvic region were obtained. The radiopharmaceutical uptake in those images was seen in the vertebrae, pelvis, and sternum. Alongside, there was a normal distribution of Tc-99m pertechnetate at salivary gland and stomach in images. These data provided that Tc-99m sodium pertechnetate binded with in vivo phosphate because of high bone turnover in this patient who had hyperphosphatemia.