Primary Hyperparathyroidism: Treatment, Cost and Side Effects

Primary hyperparathyroidism is usually caused due to enlargement of at least two parathyroid glands, in rare cases non-cancerous tumor might also be a cause. This disease results in lower level of calcium in the bones and excessive amount of calcium in the blood. If the calcium levels are not decreasing at an alarming rate, then it can be cured by diet and excessive intake of water to avoid kidney stones. But with patients with high levels of calcium in their blood, surgery is the most favorable option. Other options include taking a drug named Calcimimetics, which tricks the gland into making less PTH hormone. This method is usually prescribed when the surgery is unsuccessful or not an option. Bisphosphonates is another drug which prevents the loss of calcium from bones and may lessen osteoporosis while hormone replacement therapy is more suitable for women who have been through menopause and have signs of osteoporosis.

Hyperparathyroidism is diagnosed by an elevated level of parathyroid hormone in the blood. Surgery known as parathyroidectomy is the most common and effective method of treatment for primary hyperparathyroidism and provides a cure in almost 95 per cent of the cases. Surgery involves the removal of the affected or enlarged parathyroid glands or tumors on the glands (adenoma). Surgery can also be performed as an outpatient procedure through very small incisions in the neck, with the help of local anesthesia. Complications from surgery are rare. Surgery is the main and only effective method of treatment for primary hyperparathyroidism. The traditional method of parathyroid surgery was bilateral neck exploration, which is a safe and effective method. A more limited approach, referred to as focused parathyroidectomy involves the removal of only the hyperactive gland that is defined on preoperative localizing tests. It is also termed as ' minimally invasive parathyroid surgery'. The duration of the surgery ranges from 20 minutes to several hours, depending upon the complexity of the surgery. Radio guided parathyroidectomy is also a type of focused parathyroidectomy. Video assisted parathyroidectomy or endoscopic parathyroidectomy are also a safe method of treatment.

Patients above 80 are prone to the same risk as that of patients below 50, hence everyone is eligible for treatment, though patients with heart issues and other such complications are taken extensive care of and are at a higher risk of being prone to side-effects.

Some doctors will prefer to not refer their patients for surgery if they have only a mild form of primary hyperparathyroidism. Asymptomatic patients who do not meet surgical guidelines are safe, without surgery, at least for a couple of years. Surgery or parathyroidectomy is generally appropriate for most of the patients with a high rate of cure. But some patients who cannot undergo surgery are provided with medical therapy. Patients with medical contraindications and extenuating medical issues, failed prior neck surgery and unresectable parathyroid carcinoma are not eligible for the surgery. There are also individuals who simply refuse surgery.

Patients who undergo this surgery do not really expect or experience any damage to the nerves that are connected to the vocal cords, which can possibly affect the speech. However, rarely patients tend to lose their healthy parathyroid tissue. They further develop chronic low calcium levels. This can lead to the requirement of lifelong treatment and intake of vitamin D and calcium. The complication, medically termed as hypoparathyroidism is definitely a rare case and this entirely depends on the body condition and capacity of the patients.

There is a risk of mild to moderate hypocalcemia after the parathyroidectomy or parathyroid surgery. Such patients require prolonged calcium supplementation. Hypocalcemia is a condition where calcium level in the blood decreases causing calcium depletion from the bones, leading to brittle bones and osteoporosis. Patients who have undergone surgery, must be observed for hematoma (blood clot) and evaluated for hypocalcemia or symptoms of hypocalcemia. They must be followed up to assess for cure defined as eucalcemia at more than six months. Calcium supplements may be indicated post the operation. Hematomas can be treated by drainage and incision. Any signs of bleeding from the neck, para thyroid hormone (PTH) levels and blood calcium levels will be monitored post treatment. The patients must have their calcium levels checked at least once a year. A bone density scan (DEXA) must be done, one year after surgery.

Parathyroid surgery can be performed as an outpatient surgery or with an overnight hospital stay. The recovery after surgery may take around one to six weeks depending upon the age and response of the patient towards the medication. Patients who have undergone the surgery will be monitored by the doctors and nurses for a period of 4 to 8 hours. This time will also let the patient recover from the anesthetics. The amount of time take for recovery depends on the individual patient, the extent of surgery and the recommendation of the surgeon. The patient is discharged soon after that if they meet the suitable health requirements; else they are kept overnight, checked in the morning and then discharged.

The price of treatment of primary hyperparathyroidism ranges from around INR 50,000 to INR 65,000, depending upon the hospital. The price of treatment in India goes upto around INR 10,25,500 rupees for surgery and INR 5,18,500 for cinacalcet.

The results of the treatment are permanent in majority of the cases.

The drug Cinacalcet is approved by The Food and Drug administration to fix the patients suffering from hyperparathyroidism. This drug decreases the parathyroid hormone (PTH), calcium and phosphorus levels in the body. Usually, the chronic kidney disease or parathyroid cancer with its calcimimetic properties is the reason behind the occurrence of this issue. This is prescribed by doctors when the disorder is not successfully cured by surgical procedures or when the patient cannot undergo surgery due to a variety of causes. Muscular and joint pains, nausea, diarrhea and respiratory infections are the most common side effects of this drug. Hormone replacement therapy is an estrogen therapy to help retain calcium in the bones in menopausal women who experience symptoms of osteoporosis. There are risks of blood clots and cancer in the breast when this therapy is used for a long time. There will be pain in the breast, dizziness and nausea as side effects. Bisphosphonates are an alternative that helps to prevent the loss of calcium as an effect of osteoporosis in the bones. Osteoporosis caused by hyperparathyroidism may be lessened by bisphosphonates.