What is an alternative to surgery for hyperparathyroidism?

Dr. Jack Merendino, MD
Endocrinology Diabetes & Metabolism
In most cases surgery is by far the best option for the treatment of hyperparathyroidism. Most patients with this condition have a benign tumor or “adenoma” of one of the four parathyroid glands. Provided that you can find out which of the glands is abnormal, surgery is usually fairly easy and the person will recover quite quickly.

Often the bigger question is whether a given person with hyperparathyroidism merits surgery or not. There is no universal agreement on who should have parathyroid surgery, but it is clear that many people with mild cases of hyperparathyroidism have very few or no symptoms and only mildly abnormal laboratory test results. Most doctors would simply monitor such patients. The usual indications for surgery include very high blood or urine calcium levels, kidney stones, rapidly progressive osteoporosis or certain symptoms such as fatigue, muscle aches or difficulty with focus or memory. Unfortunately, many of these “neuro-psychiatric” symptoms are highly subjective and they may be quite subtle. Surgery also tends to be recommended to younger individuals with the recognition that they may develop problems over the long-term that could be prevented by surgical treatment.

For those patients with hyperparathyroidism who need treatment but are not deemed good candidates for surgery, perhaps because they are too elderly or frail or have other serious medical problems which would increase the risk of surgery, cinacalcet (brand-name Sensipar) can be used to lower calcium levels. It is expensive, often has side effects and really hasn’t been studied for the long-term treatment of hyperparathyroidism. Bisphosphonate drugs such as alendronate (Fosamax) or zaledronic acid (Reclast) may lower calcium levels and calcitonin has been used successfully in some cases. But overall, no drug is nearly as safe or as effective as surgery in treating this condition.
For primary hyperparathyroidism, one alternative to have an operation is to observe closely. Blood calcium and parathyroid hormone (PTH) levels will be checked on a routine basis and routine follow-up visits to assess for development of symptoms will be scheduled. Studies have compared the outcomes of those patients who undergo parathyroidectomy versus those patients who do not undergo curative surgery. Many patients who are observed will go on to have increasing blood calcium and PTH levels or will develop one or more indications (reasons) for surgery.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.