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Treatments and drugs
By Mayo Clinic staff
Watchful waiting
Your doctor may recommend no treatment and regular monitoring if:
- Your calcium levels are only slightly elevated
- Your kidneys are functioning normally
- Your bone density is normal or only slightly below normal
- You have no other symptoms that may improve with treatment
If you choose this watch-and-wait approach, you'll likely need a test to check your blood-calcium levels at least twice a year and have other monitoring tests done at least once a year.
Surgery
Surgery is the most common treatment for primary hyperparathyroidism and provides a cure in at least 90 percent of all cases. A surgeon will remove only those glands that are enlarged or have a tumor (adenoma). If all four glands are affected, a surgeon will likely remove only three glands and perhaps a portion of the fourth — leaving some functioning parathyroid tissue.
Surgery may be done as an outpatient procedure, allowing you to go home the same day. In such cases, the surgery is done through very small incisions in the neck, and you receive only local anesthetics.
Complications from surgery aren't common. Risks include:
- Damage to nerves controlling the vocal cords
- Long-term low calcium levels requiring the use of calcium and vitamin D supplements
Drugs
Medications to treat hyperparathyroidism include the following:
- Calcimimetics. A calcimimetic is a drug that mimics calcium circulating in the blood. Therefore, the drug may trick the parathyroid glands into releasing less parathyroid hormone. This drug is sold as cinacalcet (Sensipar). The Food and Drug Administration approved cinacalcet to treat hyperparathyroidism caused by chronic kidney disease or parathyroid cancer. Some doctors may prescribe it to treat primary hyperparathyroidism, particularly if surgery hasn't successfully cured the disorder or a person isn't a good candidate for surgery.
- Hormone replacement therapy. For women who have gone through menopause and have signs of osteoporosis, hormone replacement therapy may help bones retain calcium. This treatment, usually a combination estrogen and progestin, doesn't address the underlying problems with the parathyroid glands. Prolonged use of hormone replacement therapy can increase the risk of cardiovascular disease and some cancers. Work with your doctor to evaluate the risks and benefits to help you decide what's best for you.
- Bisphosphonates. Bisphosphonates also prevent the loss of calcium from bones and may lessen osteoporosis caused by hyperparathyroidism.
- Rodgers SE, et al. Primary hyperparathyroidism. Current Opinion in Oncology 2008;20:52.
- The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism. Endocrine Practice. 2005;11:49.
- Hyperparathyroidism. National Institute of Diabetes and Digestive and Kidney Diseases. http://www.endocrine.niddk.nih.gov/pubs/hyper/hyper.htm. Accessed March 23, 2009.
- El-Hajj Fuleihan G. Clinical manifestations of primary hyperparathyroidism. http://www.uptodate.com/home/index.html. Accessed March 23, 2009.
- Taniegra ED. Hyperparathyroidism. American Family Physician. 2004;69:333.
- Bringhurst FR. Hormones and disorders of mineral metabolism. In: Kronenberg, HM, et al., eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/127508547-4/0/1555/168.html#4-u1.0-B978-1-4160-2911-3..50029-7--p1224. Accessed March 23, 2009.
- Dietary supplement fact sheet: Vitamin D. National Institutes of Health Office of Dietary Supplements. http://ods.od.nih.gov/factsheets/VitaminD_pf.asp. Accessed March 24, 2009.
- Dietary supplement fact sheet: Calcium. National Institutes of Health Office of Dietary Supplements. http://ods.od.nih.gov/factsheets/Calcium_pf.asp. Accessed March 24, 2009.
- Phosphorus. Foods Standards Agency (UK). Accessed March 25, 2009.
- Wuthrich RP, et al. The role of calcimimetics in the treatment of hyperparathyroidism. European Journal of Clinical Investigation. 2007;37:915.
- Silverberg SJ, et al. Management of asymptomatic primary hyperparathyroidism. http://www.uptodate.com/home/index.html. Accessed March 23, 2009.
