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Although not all patients require surgery, the definitive therapy for treating this disorder is surgical removal of the parathyroid after it has been localized through nuclear medicine scanning and an ultrasound examination of the neck. Center surgeons are skilled at removing these glands with small incisions. They have the ability to measure parathyroid hormone concentrations in the operating room to help make sure that the levels drop after removal of the parathyroid gland, indicating that the abnormal gland was identified and appropriately treated. There are clinical trials currently examining medical therapy for hyperparathyroidism for those individuals who wish to avoid surgery or are too ill to undergo surgery.
When calcium levels become too high, removal of one or more of the parathyroid glands may be necessary (parathyroidectomy). A high resolution ultrasound or other nuclear medicine scan may be necessary to help the surgeon identify the precise location of the overactive gland(s). To preserve gland function, any remaining gland tissue can be transplanted to another site in the neck, or in the arm.
The generally recognized indications for referring a patient for surgical removal of the abnormal parathyroid include:
- Serum calcium that is persistently over 1 mg/dl of the upper limit normal for the laboratory
- Presence of kidney stones, osteoporosis at any site, peptic ulcer disease, pancreatitis, or kidney failure
- A 24-hour urine calcium that is above the upper limit of normal
- Age under 50 years
An experimental trial is being performed at Cedars-Sinai that involves giving a calcium sensing receptor blocker (SENSIPAR, Cinacalcet) to patients with primary hyperparathyroidism. This results in a lowering of the serum calcium and may improve symptoms and bone density.