Primary hyperparathyroidism (pHPT)
Indications for surgery in confirmed primary hyperparathyroidism:
- Serum calcium > 3 mmol/l
- Organ manifestations (see under “Symptoms – Complaints”).
- Dysfunction (see under “Symptoms – Complaints”).
- Experienced hypercalcemic crisis (combination of cardiac arrhythmias/arrhythmias, vomiting/vomiting, nausea/nausea, fever, desiccosis/dehydration, polyuria/increased urination, impaired consciousness).
- Mineral salt content of bone more than 2 SD (standard deviation; standard deviation) below the sex-matched norm
- Age <50 years
Surgery should be performed in all symptomatic patients. The adenomatous enlarged epithelial bodies (> 50 mg in weight) are removed in isolation.
If there is hyperplasia (enlargement) of all epithelial corpuscles, parathyroidectomy (removal of pathologically (pathologically) altered parathyroid glands) is performed.
In order for the body to continue to have parathyroid hormone, if all four epithelial corpuscles are enlarged, the surgeon preserves a portion of the fourth epithelial corpuscle. Postoperatively, monitoring of calcium levels is required.
Parathyroidectomy is the only curative (cure as a goal) measure of symptomatic primary hyperparathyroidism. It is successful in 95-99% of cases.
The complication rate is very low at 1-3%.
Indications for surgery in asymptomatic patients:
- Young patients
- Very pronounced hypercalcemia (calcium excess).
- Impaired renal function
Secondary hyperparathyroidism (sHPT)
If the underlying disease cannot be cured and the patient is symptomatic, parathyroidectomy is also recommended.
Tertiary hyperparathyroidism (tHPT)
The therapeutic approach to tertiary hyperparathyroidism with hypercalcemia (calcium excess) is analogous to primary hyperparathyroidism.Osteoclastomas and ectopic mineralizations slowly regress spontaneously after therapy for hyperparathyroidism. Surgical therapy is indicated only in rare and marked cases.
