Surgery an option for mild parathyroid disease

By Will Boggs, MD

NEW YORK (Reuters Health) - Even though surgery to remove diseased parathyroid glands (also called parathyroidectomy) is not indicated in mild cases of hyperparathyroidism, surgery may in fact benefit such patients in some cases, according to a study.

The four parathyroid glands lie behind the thyroid gland, located at the front of the throat. Hyperparathyroidism occurs when a tumor 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.

"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," Dr. Claudio Marcocci from the University of Pisa, Italy told Reuters Health.

Marcocci and colleagues 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, the authors report, 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, the report indicates.

Calcium and parathyroid hormone levels normalized 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 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.

"Getting free of a curable disease may also be better for the patient," Marcocci said. "On the other hand, if the patient feels well even without surgery, current data indicate that also this approach is rather safe."

In individual cases of mild asymptomatic disease, "the question of whether it is worth to expose the patient to the risk of surgery should be taken into account," Marcocci concluded. "In our series we did not have surgical complications, but, as mentioned in the paper, we had very experienced parathyroid surgeons."

SOURCE: The Journal of Clinical Endocrinology & Metabolism, August 2007.