THYROID AND PARATHYROID DISEASES: DIAGNOSIS, TREATMENT AND SURGERY WITH CURRENT APPROACHES

thyroid_and_parathyroid_diseasesnevinsakoglukapak1-0-25

SURGICAL INDICATIONS IN PARATHYROID DISEASES

Nevin Sakoğlu

İstanbul Medipol University, Faculty of Medicine, Department of General Surgery, İstanbul, Türkiye

Sakoğlu N. Surgical Indications in Parathyroid Diseases. Kesici U, ed. Thyroid and Parathyroid Diseases: Diagnosis, Treatment and Surgery with Current Approaches. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.67-77.

ABSTRACT

Hyperparathyroidism (HPT) is a condition characterized by the overproduction of parathyroid hor- mone (PTH) by one or more of the parathyroid glands, leading to elevated calcium levels in the blood. This can result in a range of symptoms and complications, including osteoporosis, kidney stones, fatigue, and gastrointestinal issues. While many patients with hyperparathyroidism are asymptomatic, surgery is often required in specific situations. The primary indication for surgery in hyperparathyroid- ism is symptomatic disease. If a patient presents with symptoms such as bone pain, fractures, kidney stones, or neuromuscular disturbances, surgical intervention is typically recommended to remove the overactive parathyroid gland(s). This is particularly true when the symptoms are severe or progressive. Surgery is also indicated in cases of asymptomatic hyperparathyroidism if certain criteria are met. These criteria include a serum calcium level that is significantly above normal, a reduced bone mineral density (particularly at the spine or hip), the presence of kidney stones, or a history of fracture due to osteopenia or osteoporosis. Additionally, surgery may be recommended if the patient is under 50 years of age, as the long-term risks of untreated hyperparathyroidism can increase over time. Patients with a diagnosis of primary hyperparathyroidism (due to a parathyroid adenoma or hyperplasia) often benefit from parathyroidectomy, which is typically performed via minimally invasive techniques. For secondary hyperparathyroidism, commonly seen in chronic kidney disease, surgery may be necessary when medical management fails to control calcium and phosphate imbalances. Ultimately, surgical management aims to relieve symptoms, prevent complications, and improve overall quality of life. It is essential for healthcare providers to carefully evaluate each patient’s individual situation to determine the most appropriate treatment approach.

Keywords: Parathyroid diseases; Hyperparathyroidism; Management and surgical treatment

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