What Is the Treatment of Primary Hyperparathyroidism?
Primary hyperparathyroidism (PHPT) requires careful assessment to determine whether and when definitive intervention is appropriate. Patients range from those with overt symptoms to those identified incidentally, and the management pathway differs accordingly. The structured protocol below addresses patient selection and clinical goals.
Treatment Approach
Parathyroidectomy — surgical removal of the affected parathyroid tissue — is the only definitive treatment for PHPT. The protocol defines the specific clinical scenarios in which surgery is indicated or should be considered, covering both symptomatic and asymptomatic presentations.
Treatment Goals
Correction of hypercalcaemia with normalisation of serum calcium, and sustained improvement of bone mineral density.
References
DOI: 10.1111/cen.14659
- Surgery is the only definitive treatment of PHPT.
- Parathyroidectomy is indicated for all symptomatic patients who are fit for surgery, in those with osteoporosis on DXA criteria or fragility fracture, in those with nephrolithiasis, nephrocalcinosis and those with deteriorating renal function, and suggested for those with a glomerular filtration rate (GFR) of <60 ml/min, in the absence of another explanation.
- Parathyroidectomy is indicated for all asymptomatic patients <50 years old, and should be considered for asymptomatic patients who are fit for surgery and have a life expectancy of ten years or more.
- Surgical removal of neoplastic parathyroid tissue will correct hypercalcaemia and its symptoms and improve end‑organ damage.
- Operative cure of primary hyperparathyroidism leads to a sustained improvement of BMD and reduced fracture risk.
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