Parathyroid Hyperfunction (Hyperparathyroidism): Drug Therapy

Therapeutic target

  • Normalization of serum calcium levels.

Therapy recommendations – primary hyperparathyroidism (pPHT)

  • For patients with symptomatic primary hyperparathyroidism who cannot be operated on or cannot be operated on immediately:
  • Other possible medications – v. a. to protect against bone loss:
  • Osteoporosis prophylaxis in postmenopausal women:
    • Bisphosphonates
  • Caveat (Attention!): Do not use thiazide diuretics (dehydrating drug) and digitalis (antiarrhythmic drug)!
  • In case of higher degree hypercalcemia (calcium excess):
    • 9% saline i.v.; 4-6 (10) l/day.
      • To enhance calcium excretion and for rehydration (fluid balance).
      • Contraindications: severe heart failure (cardiac insufficiency), severe renal insufficiency (renal insufficiency).
  • In hypercalcemic crisis with renal failure:
  • Postoperatively, hypocalcemia (calcium deficiency) may occur (“hungry bone syndrome”) – to normalize calcium homeostasis, calcium or, more rarely, vitamin D substitution is recommended:
    • 1-1.5 g calcium / day
    • 0.25-0.5 µg calcitriol/day

Therapy recommendations – Secondary hyperparathyroidism (sPHT) in renal failure

  • Glomerular filtration rate (GFR) < 50-60 ml/min:
  • If necessary, administration of calcium
  • Therapy of hyperphosphatemia (excess phosphate):
    • Use of phosphate binders
      • V. a. calcium-containing phosphate binders, calcium-free phosphate binders such as sevelamer, lanthanum carbonate.
      • Cave: aluminum-containing phosphate binders because of toxicity problems only use in the short term!
    • Adequate dialysis
  • To decrease parathyroid hormone:

Therapy recommendations – tertiary hyperparathyroidism (tHPT)