Objective To investigate the clinical diagnosis and treatment for primary hyperparathyroidism with concomitant thyroid diseases. Methods The clinical data of 40 cases diagnosed as primary hyperparathyroidism with concomitant thyroid diseases including manifestation, preoperative qualitation and localization, and surgical treatment and results were retrospectively analyzed. Results The 40 cases were composed of 4 parathyroid adenomas with thyroid papillary carcinomas, 28 parathyroid adenomas with nodular goiters, 6 parathyroid adenomas with thyroid adenomas, 1 parathyroid hyperplasia with nodular goiter, and 1 parathyroid carcinoma with thyroid adenoma. The diagnostic sensitivities of localization for primary hyperparathyroidism with concomitant thyroid diseases by ultrasound, by computerized tomography (CT), and by radioisotope (99Tcm) scanning were 82.5% (33/40), 80.0% (32/40) and 90.0% (36/40), respectively, and the combined sensitivity was 97.5% (39/40). The surgical treatments included resection of parathyroid adenoma with subtotal thyroidectomy in 34 cases, resection of parathyroid adenoma with total thyroidectomy in 3 cases, bilateral exploration of parathyroid with subtotal thyroidectomy in 1 case, and unilateral parathyroidectomy with thyroidectomy and neck lymphonodes clearance in 2 cases. ConclusionFor primary hyperparathyroidism with concomitant thyroid diseases, the sensitivity of preoperative localization could be raised by combining ultrasound, CT with radioisotope scanning, and surgical resection is the main treatment, which includes the main operation of resection of parathyroid adenoma with subtotal or total thyroidectomy.