Hyperparathyroidism surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Surgery

Symptomatic hyperparathyroidism is an indication for surgery. However, there are guidelines for surgery in asymptomatic priamry hyperparathyroidism

Guidelines for Surgery in Asymptomatic PHPT
Factors	Criteria
Serum calcium	1.0 mg/dL (0.25 mmol/L) (>upper limit of normal)
Skeletal:	Bone mineral density (BMD) by dual X-ray absorptiometry (DXA): T-score < −2.5 at lumbar spine, total hip, femoral neck, or distal 1/3 radius Vertebral fracture by X-ray, CT, MRI, or Vertebral fracture assessment (VFA)
Renal	Creatinine clearance < 60 cc/min 24-h urine for calcium >400 mg/d (>10 mmol/d) and increased stone risk by biochemical stone risk analysis Presence of nephrolithiasis or nephrocalcinosis by x-ray, ultrasound, or CT
Age	<50
Note(1): Patients need to meet only one of these criteria to be advised to have parathyroid surgery. They do not have to meet more than one. Note(2): Surgery is also indicated in patients for whom medical surveillance is neither desired nor possible and in patients opting for surgery, in the absence of meeting any guidelines, as long as there are no medical contraindications. Note(3): Consistent with the position established by the ISCD, the use of Z-scores instead of T-scores is recommended in evaluating BMD in premenopausal women and men younger than 50 y (11). Note(4): Most clinicians will first obtain a 24-hour urine for calcium excretion. If marked hypercalciuria is present (>400 mg/d [>10 mmol/d]), further evidence of calcium-containing stone risk should be sought by a urinary biochemical stone risk profile, available through most commercial laboratories. In the presence of abnormal findings indicating increased calcium-containing stone risk and marked hypercalciuria, a guideline for surgery is met.