Treatment

Watchful waiting

Your doctor may recommend no treatment and regular monitoring if:

• Your calcium levels are only slightly elevated
• Your kidneys are working normally, and you have no kidney stones
• Your bone density is normal or only slightly below normal
• You have no other symptoms that may improve with treatment

If you choose this watch-and-wait approach, you'll likely need periodically scheduled tests to monitor your blood-calcium levels and bone density.

Surgery

Surgery is the most common treatment for primary hyperparathyroidism and provides a cure in most cases. A surgeon will remove only those glands that are enlarged or have a tumor.

If all four glands are affected, a surgeon will likely remove only three glands and perhaps a portion of the fourth — leaving some functioning parathyroid tissue.

Surgery may be done as an outpatient procedure, allowing you to go home the same day. In such cases, the surgery can be done through very small cuts (incisions) in the neck, and you receive only local anesthetics.

Complications from surgery aren't common. Risks include:

• Damage to nerves controlling the vocal cords
• Long-term low calcium levels requiring the use of calcium and vitamin D supplements

Drugs

Medications to treat hyperparathyroidism include the following:

• Calcimimetics. A calcimimetic is a drug that mimics calcium circulating in the blood. The drug may trick the parathyroid glands into releasing less parathyroid hormone. This drug is sold as cinacalcet (Sensipar).

  Some doctors may prescribe cinacalcet to treat primary hyperparathyroidism, particularly if surgery hasn't successfully cured the disorder or a person isn't a good surgery candidate.

  The most commonly reported side effects of cinacalcet are joint and muscle pain, diarrhea, nausea, and respiratory infection.

• Hormone replacement therapy. For women who have gone through menopause and have signs of osteoporosis, hormone replacement therapy may help bones retain calcium. This treatment doesn't address the underlying problems with the parathyroid glands.

  Prolonged use of hormone replacement therapy can increase the risk of blood clots and breast cancer. Work with your doctor to evaluate the risks and benefits to help you decide what's best for you.

  Some common side effects of hormone replacement therapy include breast pain and tenderness, dizziness, and headaches.

• Bisphosphonates. Bisphosphonates also prevent the loss of calcium from bones and may lessen osteoporosis caused by hyperparathyroidism. Some side effects associated with bisphosphonates include low blood pressure, a fever and vomiting. This treatment doesn't address the underlying problems with the parathyroid glands.