From the Guidelines
Parathyroid gland removal (parathyroidectomy) is primarily indicated for patients with primary hyperparathyroidism who have symptomatic disease or meet specific criteria, including serum calcium levels greater than 1 mg/dL above the upper limit of normal, kidney dysfunction with creatinine clearance less than 60 mL/min, bone density T-score below -2.5 at any site or evidence of vertebral fracture, age under 50 years, or nephrolithiasis/nephrocalcinosis, as supported by the most recent guidelines 1.
Indications for Parathyroidectomy
The main indications for parathyroidectomy include:
- Serum calcium levels greater than 1 mg/dL above the upper limit of normal
- Kidney dysfunction with creatinine clearance less than 60 mL/min
- Bone density T-score below -2.5 at any site or evidence of vertebral fracture
- Age under 50 years
- Nephrolithiasis/nephrocalcinosis
- Severe hypercalcemia (>12 mg/dL) or hypercalcemic crisis
Secondary Hyperparathyroidism
Secondary hyperparathyroidism refractory to medical management in patients with end-stage renal disease may require subtotal parathyroidectomy when PTH levels remain persistently elevated despite treatment with calcimimetics like cinacalcet, as suggested by studies 1.
Parathyroid Carcinoma
Parathyroid carcinoma necessitates en bloc resection of the affected gland with surrounding tissues, as it is a rare but serious condition that requires prompt and effective treatment.
Surgical Treatment
Surgery offers definitive treatment with cure rates exceeding 95% for primary hyperparathyroidism when performed by experienced surgeons, though patients should be counseled about potential risks including recurrent laryngeal nerve injury, hypoparathyroidism, and the need for calcium supplementation postoperatively, as noted in the guidelines 1.
From the Research
Indications for Parathyroid Gland Removal
The indications for parathyroid gland removal, also known as parathyroidectomy, are as follows:
- Symptomatic primary hyperparathyroidism 2, 3, 4, 5
- Asymptomatic primary hyperparathyroidism in patients younger than 50 years, with severe hypercalcemia, markedly reduced creatinine clearance, and/or profound osteopenia 2, 5
- Secondary hyperparathyroidism that is medically refractory, with persistent parathyroid hormone levels >800 pg/ml for >6 months, and concomitant disorders such as hypercalcemia, hyperphosphatemia, tissue or vascular calcification, and/or worsening osteodystrophy 6
- Patients with primary hyperparathyroidism who have osteoporosis, osteopenia, kidney dysfunction, urolithiasis, cognitive dysfunction, or cardiovascular disease 4, 5
Patient Selection
Patient selection for parathyroidectomy is crucial, and the decision to operate should be based on individual patient characteristics, including:
- Age: patients younger than 50 years with asymptomatic primary hyperparathyroidism 2
- Symptom severity: patients with symptomatic primary hyperparathyroidism 2, 3, 4, 5
- Laboratory values: patients with severe hypercalcemia, markedly reduced creatinine clearance, and/or profound osteopenia 2, 5
- Presence of concomitant disorders: patients with secondary hyperparathyroidism and concomitant disorders such as hypercalcemia, hyperphosphatemia, tissue or vascular calcification, and/or worsening osteodystrophy 6