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Surgery safe for treating mild parathyroidism

Even though surgery to remove diseased parathyroid glands is not indicated in mild cases of hyperparathyroidism, it may benefit such patients in some cases.

Surgery safe for treating mild parathyroidism

Even though surgery to remove diseased parathyroid glands (also called parathyroidectomy) is not indicated in mild cases of hyperparathyroidism, it may in fact benefit such patients in some cases. The four parathyroid glands lie behind the thyroid gland, located at the front of the throat. Hyperparathyroidism occurs when a tumour develops in one or more of the glands, causing it to produce too much parathyroid hormone, which regulates calcium levels in the body. The bone-thinning disease osteoporosis, kidney stones, and peptic ulcers are frequent complications of having excess amounts of parathyroid hormone. Researchers from the University of Pisa, Italy evaluated the beneficial effects of parathyroidectomy versus conservative management (no surgery) in 50 patients with mild asymptomatic hyperparathyroidism who did not meet guidelines for parathyroid surgery. There were no surgical complications, and there were no clinical signs of lingering hyperparathyroidism in the surgery group during follow-up. One patient in the no-surgery group had a kidney stone and one had a fracture during follow-up. Calcium and parathyroid hormone levels normalised in all but one of the patients who underwent parathyroidectomy. Three patients in the no-surgery group showed abnormally high calcium levels in urine and one patient showed high calcium levels in urine and blood during follow up. Patients in the surgery group showed an increase in bone mineral density one year after surgery, whereas patients in the no-surgery group showed decreases in bone mineral density. Parathyroidectomy was associated with modest but significant improvements in quality of life, compared with conservative management. Thus, in individual mild asymptomatic cases, when an experienced parathyroid surgeon is available, parathyroidectomy could be considered with the possibility of measurable benefits for the patient. Getting free of a curable disease may also be better for the patient. On the other hand, if the patient feels well even without surgery, current data indicate that this approach is safe as well.
The Journal of Clinical Endocrinology & Metabolism,
August 2007
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