OBJECTIVE: Primary hyperparathyroidism (pHPT) is often accompanied by underlying thyroid pathology and 1 to 36% of these thyroid pathologies are malignant. How the identification of these lesions affects patient management is unclear. We present a single-center experience with the prevalence of concomitant thyroid cancer in patients who underwent parathyroidectomy for pHPT. MATERIALS AND METHODS: This was a retrospective cohort study. Two hundred-two patients with primary hyperparathyroidism included study. Demographic data, clinical findings, and final histopathological diagnosis were recorded retrospectively. RESULTS: Preoperative cervical ultrasound examination revealed co-existent thyroid abnormalities in 117 (57.9%) patients. Mean age of these patients was 57.8 ± 12.2 years and 88% were female. Sixty-three (53.9%) of the patients with thyroid abnormalities, underwent preoperative fine needle aspiration biopsy (FNAB). Cytology result was malignant in one (1.6%) patient, benign in 47(85.7%) patients, indeterminate in six (9.5%) patients and Hurthle cell neoplasm in two (3.2%) patients. Ninety-four (80.3%) of the patients underwent simultaneous thyroid surgery. Final pathology of the thyroid specimen was malignant in 26 (12.9%) patients. Sixteen of the malignant patients had preoperative FNAB. Preoperative FNAB result of these patients was malignant in one patient, indeterminate in two patients and benign in 13 patients. CONCLUSION: By implementing a comprehensive approach to patients with pHPT who present with thyroid disease, concomitant pathology may be elucidated preoperatively. But, this approach will not facilitate the detection of otherwise unsuspected thyroid cancer in an endemic goitre region.