The American Association of Endocrine Surgeons, Patient Education Site

Treatment of primary hyperparathyroidism

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Who should have parathyroid surgery?

Symptomatic disease

Patients with osteoporosis, a history of kidney stones, or life-threatening episodes of hypercalcemia should have an operation. A rare indication (i.e. reason) for an operation is an extreme form of bone disease called "osteitis fibrosa cystic" in which the bone becomes so soft that it becomes deformed. Osteitis fibrosa cysticaOsteitis fibrosa cystica - An extreme form of bone disease in which the bone become so soft that it deforms. is very rare in developed countries. Patients younger than 50 should have an operation because there is a high likelihood of developing worsening or symptomatic disease.

Asymptomatic disease (NIH Criteria)

Asymptomatic primary hyperparathyroidism is defined as patients who do not have a history of the classic symptoms (i.e. kidney stones or osteitis fibrosa cystica). Patients may have many of the non-classic symptoms (fatigue, worsening memory, worsening concentration, insomnia, cardiovascular disease, etc). Many patients with asymptomatic primary hyperparathyroidism will have worsening disease over time and would benefit from an operation. Other than being younger than 50 years, there are no criteria that predict which patients will have worsening disease. The Third International Workshop on Asymptomatic Primary Hyperparathyroidism released guidelines stating which patients with asymptomatic primary hyperparathyroidism should have an operation:

MeasurementsGuidelines for surgery
Serum calcium level1.0 mg/dl above normal
24 hour urinary CalciumCurrently not indicated
(however, some experts use a calcium excretion
>400mg/24 hours)
Kidney functionLess than 60ml/min
Bone mineral densityOsteoporosis (T-score less than -2.5 at any site) or previous fracture
AgeAge < 50

Many physicians feel that these guidelines are an excellent start, but that there are more people with asymptomatic disease who would benefit from an operation. Ultimately, the decision whether or not you should have an operation will be made after discussing your specific risks factors and potential benefits with your surgeon and medical team.

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