From the Guidelines
Surgical removal of the affected parathyroid gland(s) through parathyroidectomy is the recommended treatment for hyperparathyroidism, as it is the most effective way to normalize calcium levels and prevent long-term complications, as supported by the most recent guidelines 1. The treatment approach for hyperparathyroidism depends on the type and severity of the condition. For primary hyperparathyroidism, parathyroidectomy is the definitive treatment, especially for symptomatic patients or those with significant bone loss, kidney stones, or high calcium levels. There are two accepted curative operative strategies for primary hyperparathyroidism: bilateral neck exploration (BNE) and minimally invasive parathyroidectomy (MIP). BNE is a bilateral operation in which all parathyroid glands are identified and examined by the surgeon, who resects the diseased glands, while MIP is a unilateral operation utilizing limited dissection for targeted removal of only the affected gland, as described in the study 1. Key points to consider in the treatment of hyperparathyroidism include:
- The role of imaging in primary hyperparathyroidism is to localize the abnormally functioning gland or glands with high accuracy and high confidence to facilitate targeted curative surgery, as emphasized in the study 1.
- Parathyroid reoperations are surgically challenging, with lower cure rates than first-time surgery and higher complication rates, highlighting the importance of accurate preoperative localization and careful surgical planning, as discussed in the study 1.
- Medical management options, such as cinacalcet and bisphosphonates, may be considered for patients who are not candidates for surgery or have mild disease, but these should be used under the guidance of a healthcare professional and with regular monitoring of calcium levels and bone density. Overall, the goal of treatment for hyperparathyroidism is to normalize calcium levels, prevent long-term complications, and improve quality of life, and surgical removal of the affected parathyroid gland(s) is the most effective way to achieve this, as supported by the study 1.
From the FDA Drug Label
Cinacalcet tablets are indicated for the treatment of secondary hyperparathyroidism (HPT) in adult patients with chronic kidney disease (CKD) on dialysis [see Clinical Studies (14. 1)]. Cinacalcet tablets are indicated for the treatment of hypercalcemia in adult patients with Parathyroid Carcinoma [see Clinical Studies(14.2)]. Cinacalcet tablets are indicated for the treatment of hypercalcemia in adult patients with primary HPT for whom parathyroidectomy would be indicated on the basis of serum calcium levels, but who are unable to undergo parathyroidectomy [see Clinical Studies (14.3)].
The recommended treatment for hyperparathyroidism is cinacalcet. The dosage and administration vary depending on the type of hyperparathyroidism:
- For secondary hyperparathyroidism in patients with CKD on dialysis, the recommended starting oral dose is 30 mg once daily.
- For parathyroid carcinoma and primary hyperparathyroidism, the recommended starting oral dose is 30 mg twice daily. It is essential to monitor serum calcium and phosphorus levels, as well as intact parathyroid hormone (iPTH) levels, during treatment with cinacalcet 2.
From the Research
Treatment Options for Hyperparathyroidism
The recommended treatment for hyperparathyroidism is surgery, which is the only curative treatment for primary hyperparathyroidism (pHPT) 3, 4. The goal of surgery is to remove the pathological parathyroid gland(s) and restore normal calcium and parathyroid hormone (PTH) levels.
Surgical Techniques
There are two main surgical approaches:
- Bilateral neck exploration (BNE), which is considered the gold standard procedure in parathyroid surgery 3, 4
- Minimally invasive parathyroidectomy (MIP), which is the ideal approach in selected patients with clinically and radiologically confirmed single-gland disease 3, 4
Effectiveness of Surgical Treatment
Studies have shown that parathyroidectomy is highly effective in treating primary hyperparathyroidism, with:
- High success rates in normalizing calcium and PTH levels 5, 6
- Improvement in bone mineral density after surgery 7
- Low complication rates, especially when performed by experienced surgeons 5, 6
Factors Influencing Treatment Outcomes
The effectiveness of surgical treatment can be influenced by:
- Preoperative localization studies and imaging results 3, 4
- The surgeon's experience and knowledge of parathyroid anatomy and embryology 3
- The presence of hereditary HPT or other endocrine disorders 4
- The patient's overall health and comorbidities 5, 6
Special Considerations
In patients with a high risk of hypercalcaemic crisis, urgent surgical intervention may be necessary, even in the absence of imaging tests 6. Additionally, patients with hypercalciuria may have a greater increase in bone mineral density after parathyroidectomy 7.