To explore the clinical features, diagnosis and surgical treatment of parathyroid neoplasms.From January 2003 to December 2011, a total of 51 patients were recruited. Their clinical data, presentations, examinations and surgical approaches were analyzed retrospectively.Among them, there were parathyroid adenoma (n = 32), parathyroid cysts (n = 18) and parathyroid carcinoma (n = 1). The sensitivity and positive rate of neck ultrasonography and (99)Tc(m)-methoxyisobutylisonitrile (MIBI) were 84.3% and 93.5%, 91.7% and 100.0% respectively. The high levels of serum calcium and parathyroid hormone (PTH) in 32 cases of parathyroid adenoma and 1 case of parathyroid carcinoma returned to normal after operation. The levels of serum calcium and PTH remained normal in 18 cases of parathyroid cysts.The clinical manifestations of parathyroid adenoma were complex. The serum levels of calcium and PTH and neck ultrasonography are preferred screening tools for parathyroid neoplasms.(99)Tc(m)-MIBI is suitable for tumor localization.Surgery is effective and safe for parathyroid neoplasm.Real time intraoperative monitoring of PTH is of great importance.