Strategies for Treating Hyperparathyroidism

Primary hyperparathyroidism is one of the most common causes of abnormally high blood calcium levels. Medications such as estrogen and bisphosphonates will not cure primary hyperparathyroidism, but may decrease calcium or parathyroid hormone (PTH) levels and improve bone density. Parathyroidectomy is the only known cure for primary hyperparathyroidism and is currently viewed as the optimal treatment strategy. In the hands of experienced endocrine surgeons, success rates approach 95% to 98%, according to available databases. Persistent primary hyperparathyroidism occurs when calcium levels and PTH levels do not return to normal within 6 months of a parathyroid operation. This usually happens because all of the abnormal parathyroid tissue was not removed at the first operation. This may result when inexperienced surgeons miss the diseased gland, in the presence of an ectopic gland located in a difficult-to-find location, or when patients have multiple abnormal glands. “Just because a patient has a hyperparathyroidism does not mean they will need surgery in all cases.” When calcium and PTH levels are initially normal after parathyroid surgery but become abnormal again after 6 months, patients have recurrent primary hyperparathyroidism. This type of hyperparathyroidism usually happens when one or more of the remaining glands become hyperactive. Parathyroid cancer can cause either persistent or recurrent primary hyperparathyroidism, but less than 1% of patients with primary hyperparathyroidism will be diagnosed with parathyroid cancer. Considering Reoperative Parathyroid Surgery Both persistent and recurrent primary hyperparathyroidism may require reoperative parathyroid surgery. Patients who have had significant surgery in the cervical region—particularly total thyroidectomy—should be considered as if they were undergoing a reoperation because they pose technical challenges that have resulted in suboptimal...