What're the treatments for hyperparathyroidism?
Patients with mild cases of hyperparathyroidism may not need immediate treatment if they have only slight elevations in blood calcium level and normal kidneys and bones. These patients should be regularly checked, probably as often as every six months, by physical examination and measurement of kidney function and calcium levels. A bone densitometry
measurement should be performed every one or two years. After several years with no worsened symptoms, the length of time between exams may be increased.
Patients with more advanced hyperparathyroidism will usually have all or half of the affected parathyroid gland or glands surgically removed. This surgery is relatively safe and effective. The primary risks are those associated with general anesthesia. There are some instances when the surgery can be performed with the patient under regional, or cervical block, anesthesia. Often studies such as ultrasonography prior to surgery help pinpoint the affected areas.
The treatment of hyperparathyroidism is primarily surgical. Occasionally, under special circumstances, medical treatment with drugs is indicated, but generally patients with hyperparathyroidism are either just followed or undergo surgical treatment. One class of drugs, biphosphonates, can prevent the parathyroid hormone stimulated activation of osteoclasts in the bone and thereby reduce the level of calcium in the blood and prevent the complications of hyperparathyroidism. These drugs must be given by injection every few weeks, however, and they are generally not used for long term treatment of hyperparathyroidism. Estrogens can lower calcium a little bit and are good for osteoporosis, but their effect is minimal and they are generally not a good long term solution in men, younger patients or those with symptoms or complications.
Fortunately, the surgical treatment of hyparathyroidism is very safe and very successful. When performed by a surgeon experienced in parathyroid surgery, neck exploration for hyperparathyroidism has about a 96% success rate in curing hyperparathyroidism. That means that there is about a 4% chance of the operation not correcting the hyperparathyroidism. There are basically 3 reasons why the operation might not correct the problem. First, the diagnosis might not be correct. There are a number of different things which can elevate the calcium in the blood, including cancers, some medications, some inflammatory conditions, etc.. The amount of parathyroid hormone in the blood can now be measured accurately, and proper interpretation of the results of this test has greatly increased the accuracy of diagnosis of hyperparathyroidism. Secondly, the surgeon may not be able to locate the abnormal parathyroid gland or gland in the neck. Surgeons who do a lot of parathyroid surgery are more likely to be able to find the abnormal glands, but even very experienced surgeons will not always be able to find all of the abnormal parathyroid glands and thereby correct the hyperparathyroidism . Thirdly, very occasionally the abnormal parathyroid gland or glands are not in the neck but in the chest, in which case, obviously, even the best parathyroid surgeon cannot find it by looking in the neck.