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Does everyone with hyperparathyroidism need surgery?

Dr. Jack Merendino, MD
Endocrinology Diabetes & Metabolism
Surgery is not necessary for everyone with hyperparathyroidism, though there is some disagreement about precisely who needs surgery. Generally accepted criteria for who needs surgery include anyone with calcium-based kidney stones, osteoporosis beyond that expected for age or specifically involving the long bone, and very high blood calcium levels, especially above 11.5 or 12.

Subjective symptoms often result from hyperparathyroidism and may improve with surgery. The symptoms include muscle and joint aches and pains, which can be hard to distinguish from age-related arthritis. Difficulty with focus and concentration may improve following surgery, and depression or heightened anxiety may sometimes also improve or even resolve completely. 

Although strictly speaking not an absolute criterion for surgery, most doctors tend to recommend surgery to those who are younger with the idea that the problems related to hyperparathyroidism are likely to get worse over many years and it is better to intervene early to prevent them. Therefore, one might elect to just monitor someone with hyperparathyroidism at age 80 if they have only a mild elevation in calcium and no symptoms, but to operate on someone who is 55 even if they too are asymptomatic and have only a slight calcium elevation. 
 

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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.