What type of doctor treats hyperparathyroidism?

Hyperparathyroidism Treatment: Specialist Care

Hyperparathyroidism should be managed primarily by an endocrinologist, with referral to a high-volume parathyroid surgeon when surgical intervention is indicated. 1

Primary Care Assessment and Referral

• Initial diagnosis often occurs at the primary care level through routine blood tests showing elevated calcium
• Once hyperparathyroidism is suspected, referral to an endocrinologist is the appropriate first step
• The endocrinologist will:
  • Confirm diagnosis through comprehensive laboratory testing
  • Determine the type of hyperparathyroidism (primary, secondary, or tertiary)
  • Establish severity and presence of complications
  • Develop an appropriate treatment plan

Specialist Management by Type of Hyperparathyroidism

Primary Hyperparathyroidism

• Endocrinologist: Coordinates overall care, performs initial evaluation, monitors disease progression, and manages medical therapy when appropriate
• Parathyroid Surgeon: Performs parathyroidectomy, which is the definitive treatment for symptomatic primary hyperparathyroidism 1
  • Referral to a high-volume parathyroid surgeon is specifically recommended for optimal outcomes 1
  • Surgical approaches include both Bilateral Neck Exploration and Minimally Invasive Parathyroidectomy

Secondary Hyperparathyroidism

• Endocrinologist: Primary specialist for management
• Nephrologist: Takes lead role when secondary hyperparathyroidism is due to chronic kidney disease
• Treatment follows a stepwise approach:
  1. Dietary phosphorus restriction
  2. Vitamin D supplementation
  3. Calcimimetics (cinacalcet) for more severe cases
  4. Parathyroidectomy only when medical management fails 1

Tertiary Hyperparathyroidism

• Endocrinologist: Coordinates care
• Nephrologist: Often involved due to underlying kidney disease history
• Parathyroid Surgeon: Performs parathyroidectomy when indicated
  • The American Association of Endocrine Surgeons recommends total parathyroidectomy with or without autotransplantation, or subtotal parathyroidectomy 1

Multidisciplinary Care Considerations

• Radiologist: Performs and interprets imaging studies (ultrasound, sestamibi scans, CT, MRI) for localization prior to surgery
• Rheumatologist/Orthopedist: May be consulted for bone-related complications
• Urologist: Manages kidney stone complications
• Cardiologist: Addresses cardiovascular complications from chronic calcium abnormalities

Importance of Surgical Expertise

• Outcomes are significantly better when surgery is performed by high-volume parathyroid surgeons 1
• The American Association of Endocrine Surgeons emphasizes that surgeon experience correlates with:
  • Higher cure rates
  • Lower complication rates
  • Better identification of multigland disease 2

Common Pitfalls to Avoid

• Delaying referral to an endocrinologist when hypercalcemia is detected
• Referring directly to surgery without endocrinology evaluation
• Choosing a surgeon with limited parathyroid surgery experience
• Failing to monitor for postoperative complications like hypocalcemia and "hungry bone syndrome"
• Inadequate follow-up after treatment to confirm cure (defined as eucalcemia at >6 months) 1

For optimal outcomes, patients with hyperparathyroidism should be managed through a coordinated approach between endocrinologists and experienced parathyroid surgeons, with additional specialists involved as needed based on specific complications.