Therapy

Refer for parathyroidectomy in symptomatic cases ^a

Why?

• Surgery for primary hyperparathyroidism reduces renal stones, osteitis, constipation and neuropsychiatric symptoms in symptomatic patients. It has little effect on hypertension or renal function. ^a
• Around 10% of patients develop hypoparathyroidism, 5% have a permanently hoarse voice, and surgery fails to lower calcium levels in 2%. ^a

The commonest long-term complications of parathyroidectomy are hypoparathyroidism and vocal cord paralysis

complications	% (95% CI)
transient hypocalcaemia at first post-operative week c	51% (41% to 61%)
any complication at 5 years	18% (8.6% to 27%)
persistent hypoparathyroidism at 5 years	8.8% (2.1% to 16%)
persistent vocal cord paresis at 5 years	4.4% (0.0% to 9.3%)
transient vocal cord paralysis at 5 years	2.9% (0.0% to 7.0%)
persistent hypercalcaemia at 5 years	1.5% (0.0% to 4.3%)