The clinical materials of a patient with PHPT combined with PTC and moderate anemia were collected and the relevant literatures were reviewed； the clinical characteristics， imaging appearances， diagnosis and surgery methods were discussed.

A female 42-year-old patient was admitted to hospital due to kidney stones for 15 years and PHPT for 1 month. The main manifestations of the patient included disgusted， palpitation， fatigue， mastication discomfort， and poor appetite with weight reducing 10 kg within 1 month. The patient had anemia appearance. The results of lab tests showed hypercalcemia， hyponatremia， hypopotassaemia， moderate anemia， hypoproteinemia and hyperparathyroidism. The thyroid ultrasound results showed a tumor on the left lobe of thyroid， TI-RADS4a grade； a tumor might origin from the parathyroid tissue on the right side of neck. ^{99 m}Tc MIBI dual phase imaging of parathyroid： an increased radioactivity area on the dorsal side of the upper pole of the thyroid right lobe. It was considered as hyperparathyroidism tumor. The results of abdominal ultrasound showed cholestasis， left hydronephrosis， double kidney stones. The diagnosis was parathyroid tumor， PHPT，thyroid tumor （considered as malignant），kidney stones， moderate anemia and chronic periodonititis.The patient was undergone parathyroid tumor excision and radical thyroidectomy after electrolyte disturbance and anemia was treated.

The patients with PHPT may lead to kidney stones and electrolyte disturbance because of hypercalcemia. The patient should be suspected as PHPT according to these symptoms. PHPT combined with PTC and anemia is rare even to misdiagnose. Complete examinations and correct diagnosis are necessary in order to avoid reoperation.