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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.
- Hyperparathyroidism. National Institute of Diabetes and Digestive and Kidney Diseases. http://www.endocrine.niddk.nih.gov/pubs/hyper/hyper.htm. Accessed March 3, 2011.
- El-Hajj Fuleihan G. Diagnosis and differential diagnosis of primary hyperparathyroidism. http://www.uptodate.com/home/index.html. Accessed March 1, 2011.
- El-Hajj Fuleihan G. Clinical manifestations of primary hyperparathyroidism. http://www.uptodate.com/home/index.html. Accessed March 1, 2011.
- Potts JT. Diseases of the parathyroid gland and other hyper- and hypocalcemic disorders. In: Fauci AS, et al. Harrison's Online. 17th ed. New York, N.Y.: The McGraw-Hill Companies; 2008. http://www.accessmedicine.com/content.aspx?aID=2903222&searchStr=hyperparathyroidism#2903222. Accessed Feb. 28, 2011.
- El-Hajj Fuleihan G. Pathogenesis and etiology of primary hyperthyroidism. http://www.uptodate.com/home/index.html. Accessed March 1, 2011.
- Fitzgerald PA. Hyperparathyroidism. In: McPhee SJ, et al. Current Medical Diagnosis and Treatment. 50th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/content.aspx?aID=14894&searchStr=hyperparathyroidism. Accessed March 1, 2011.
- Silverstein SJ. Management of primary hyperthyroidism. http://www.uptodate.com/home/index.html. Accessed March 1, 2011.
- Estrogen and progestin combination (Ovarian hormone therapy) (Oral route). Micromedex Healthcare Series. http://www.micromedex.com. Accessed March 3, 2011.
- Bisphosphonates. Micromedex Healthcare Series. http://www.micromedex.com. Accessed March 3, 2011.
- Dietary supplement fact sheet: Vitamin D. Office of Dietary Supplements. http://ods.od.nih.gov/factsheets/VitaminD-QuickFacts. Accessed March 3, 2011.
- Dietary supplement fact sheet: Calcium. Office of Dietary Supplements. http://ods.od.nih.gov/factsheets/Calcium-QuickFacts. Accessed March 3, 2011.
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