There are two forms of hyperparathyroidism, primary hyperparathyroidism and secondary hyperparathyroidism. Mild cases of primary hyperparathyroidism may not require any treatment but secondary hyperparathyroidism is caused by another underlying problem that doctors will need to diagnose and treat.
In cases of primary hyperparathyroidism, symptoms may not always be present and regular monitoring and a diet with a carefully balanced calcium content may be all that is required. However, in cases where hypercalcemia associated with the condition has led to symptoms or if the calcium level is very high, treatment may be required. Surgery to remove the parathyroid gland that is secreting excess parathyroid hormone (PTH) is often the first choice of treatment and cures over 95% of cases.
The overactive gland is often located before surgery using imaging techniques. A radiolaballed nuclear medicine scan called SESTAMIBI (MIBI) can specifically localise a single adenoma that may be amenable to surgery. A combination of MIBI and computed tomography offers greater specificity still.
A positive MIBI scan therefore means minimally or keyhole invasive surgery can be used to remove the adenoma. The PTH level is checked post-surgery to confirm that the condition is cured. A scar of around 1 to 2 cm in length forms at the incision wound after surgery.
For individuals who have a negative MIBI scan where no adenoma is located or if more than one gland is thought to be involved, parathyroid neck exploration surgery is used. The neck is opened up to allow the surgeon to access and examine all four parathyroid glands and remove the overactive ones. A general anesthesia is used for this type of surgery and the recovery time and hospital stay are longer.
Secondary hyperparathyroidism is caused by an underlying problem such as Vitamin D deficiency or kidney failure, which needs to be corrected to resolve the condition. Patients with chronic renal failure may be put on a restricted diet and given vitamin D supplements such as calcitrol or paricalcitol. The majority of renal failure patients with hyperparathyroidism who undergo a renal transplant find the hyperparathyroidism improves, although many still have a residual amount of hyperparathyroidism and are therefore at risk of bone loss. This is referred to as tertiary hyperparathyroidism.