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How is hyperparathyroidism treated?

Dr. Jack Merendino, MD
Endocrinology Diabetes & Metabolism
The best treatment for hyperparathyroidism is usually surgery. Most people will have a single benign tumor, referred to as an adenoma, involving one of their parathyroid glands. Nuclear medicine studies (a parathyroid Sestamibi scan) or a high-resolution ultrasound of the neck will disclose the location of the abnormal gland in about 70% to 80% of cases, and a surgeon with lots of experience with this condition can usually find and remove the abnormal gland even if the radiographic studies don’t define the location. 

Problems with surgery arise in three situations: 
  1. The parathyroid adenoma is in an unusual location.
  2. The individual has a form of hyperparathyroidism involving more than one gland, referred to as parathyroid hyperplasia.
  3. The initial diagnosis was incorrect. 
Usually the parathyroid glands are located in the neck, just adjacent to the thyroid. But during fetal development they start off in the chest and migrate upward. Occasionally they seem to get stuck, so parathyroid tumors are sometimes located in chest. Multiple glands are involved in conditions of hereditary hyperparathyroidism. This may occur as an isolated problem, but some people with hereditary forms of hyperparathyroidism have multiple endocrine neoplasia, a condition in which there are tumors involving various hormone-producing glands. Surgery for these patients is more difficult and involves removal of 3 or 3 and 1/2 of the parathyroid glands. The risk of removing too much tissue, causing hypoparathyroidism, or of re-growth of the parathyroid tissue are both high in this setting, so one needs to select a surgeon with alot of experience in this area. 

Sometimes the diagnosis of hyperparathyroidism is not made correctly. A PTH level may be high because of a low vitamin D level, a condition called secondary hyperparathyroidism. Correcting the vitamin D deficiency is the correct treatment here, not surgery. One form of hyperparathyroidism, called hypocaliuric hypercalcemia, is the result of diminished sensitivity of the parathyroid glands to calcium. They respond as though the calcium levels are lower than they actually are. This condition is usually relatively benign and most people do not really need surgery. The condition is sometimes hereditary.  It is diagnosed by finding a very low urine calcium level. 
 

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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.