Primary hyperparathyroidism and concomitant thyroid cancer is a rare disorder. Primary hyperparathyroidism is usually caused by a parathyroid adenoma, occasionally by primary parathyroid hyperplasia and rarely by parathyroid carcinoma. An association between hyperparathyroidism and well-differentiated thyroid carcinoma has been reported in many studies, but they concluded that the association between hyperparathyroidism and well-differentiated thyroid carcinoma may be coincidental. We encountered a case of primary hyperparathyroidism with concomitant papillary thyroid carcinoma. A 50-year-old female patient presented with tingling sensation, shoulder pain, muscular weakness, increased levels of serum calcium and parathyroid hormone. Ultrasonography of neck showed hypoechoic mass at left infrathyroidal region and two thyroid nodules at both thyroid lobes. Tc99m-methyl isobutyl isonitrile parathyroid scan revealed a focal hot nodule at left infrathyroidal region on both early and delayed phase. Ultrasonogram guided fine needle aspiration of left thyroid nodule was positive for papillary carcinoma later verified by postoperative histopathology. She underwent surgery at Keimyung University DongSan Medical Center and was diagnosed with primary hyperparathyroidism and concomitant papillary thyroid carcinoma. This case underlines the need for a clinical high index of suspicion for synchronous primary hyperparathyroidism and thyroid cancer. Consequently, we suggest evaluation for concomitant thyroid malignancy including a fine needle aspiration in case with primary hyperparathyroidism coexisting with suspicious nodule in thyroid gland.