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The main treatment for hyperparathyroidism is surgery to remove the enlarged gland (or glands). It can cure the disease in 95 percent of operations.
Calcimimetics are a new class of drug that turns off secretion of parathyroid hormone (PTH). They have been approved by the Food and Drug Administration for the treatment of hyperparathyroidism secondary to kidney failure with dialysis, and primary hyperparathyroidism caused by parathyroid cancer. They have not been approved for primary hyperparathyroidism, but some physicians have begun prescribing calcimimetics for some patients with this condition. Patients can discuss this class of drug in more detail with their physicians.
Some patients who have mild disease may not need immediate treatment, according to panels convened by the National Institutes of Health (NIH) in 2002. Patients who are symptom-free, whose blood calcium is only slightly elevated, and whose kidneys and bones are normal may wish to talk with their physicians about long-term monitoring. In the 2002 recommendation, periodic monitoring would consist of clinical evaluation, measurement of serum calcium levels, and bone mass measurement. If the patient and physician choose long-term follow-up, the patient should try to drink lots of water, get plenty of exercise, and avoid certain diuretics, such as the thiazides. Immobilization (unable to move) and gastrointestinal illness with vomiting or diarrhea can cause calcium levels to rise. Patients with hyperparathyroidism should seek medical attention if they find themselves immobilized, vomiting, or having diarrhea.
Are there any complications associated with parathyroid surgery?
Surgery for hyperparathyroidism is highly successful with a low complication rate when performed by surgeons experienced with this condition. About 1 percent of patients undergoing surgery experience damage to the nerves controlling the vocal cords, which can affect speech. One to 5 percent of patients lose all their parathyroid tissue and thus develop chronic low calcium levels, which may require treatment with calcium or vitamin D. The complication rate is slightly higher for hyperplasia than it is for adenoma since more extensive surgery is needed.
Are parathyroid imaging tests needed before surgery?
The NIH panels recommended against the use of expensive imaging tests to locate benign tumors before initial surgery. Such tests are not likely to improve the success rate of surgery, which is about 95 percent when performed by experienced surgeons. Simple imaging tests before surgery are preferred by some surgeons. Localization tests are useful in patients having a second operation for recurrent or persistent hyperparathyroidism.