Treatment of hyperparathyroidism and hypoparathyroidism: drugs and surgery

The goal of treatment for parathyroid disease is to relieve symptoms and return calcium and phosphorus levels to normal.

The treatment of hypoparathyroidism involves increased calcium intake and a diet adapted to this.

• Calcium supplements in the form of tablets or drinks. The recommended daily dose is 1.5-2 g of calcium per day. Side effects such as indigestion or constipation are common with high calcium intake.
• Vitamin D substitution is usually in the form of calcitriol. Preparations are available as capsules, drops or under-the-tongue sprays. The minimum daily intake of vitamin D is 2000 IU, and up to 25 000 IU per day is recommended for the treatment of hypoparathyroidism. Vitamin D helps the body absorb calcium and excrete phosphorus.
• Taking magnesium. When magnesium levels in the blood are low, calcium deficiency is accentuated, as are symptoms of hypoparathyroidism such as tetany.
• Thiazide diuretics help reduce the amount of calcium excreted in the urine.

Diet suitable for the treatment of hypoparathyroidism

Foods rich in calcium:

• Dairy products
• green leafy vegetables
• broccoli
• orange juice
• Cereals

Avoiding foods containing phosphorus:

• soft drinks that contain phosphorus in the form of phosphoric acid
• processed meat products
• hard cheeses
• nuts
• whole grain products

Treatment of primary hyperparathyroidism involves monitoring the disease and waiting (the so-called watch and wait method), medication or surgery.

Watch and wait is possible if the blood calcium level is only slightly elevated, proper kidney function is maintained without nephrolithiasis (kidney stones), bone density is normal or only slightly below normal, and there are no other serious symptoms of the disease.

Medication

Calcimimetics are drugs that merely mimic calcium circulating in the blood. Calcimimetics bind to the receptors of the parathyroid glands. The parathyroid glands are thus 'tricked' into secreting less parathyroid hormone.

The drug can trick the parathyroid glands into releasing less parathyroid hormone.

One such drug is cinacalcet. It is most often combined with vitamin D analogues.

Common side effects of cinacalcet include joint and muscle pain, diarrhea, nausea, and respiratory infections.

Postmenopausal women suffer from osteoporotic pain much more often than women with high estrogen levels. In concomitant hyperparathyroidism, osteoporosis can be significantly alleviated by hormone replacement therapy.

However, this is only a supportive treatment that does not address the parathyroid problem.

The disadvantage of this treatment is that long-term use of hormone replacement therapy increases the risk of blood clots and breast cancer.

Other side effects of this treatment include breast soreness and tenderness, dizziness and headaches.

Bisphosphonates are drugs that protect the structure of hydroxyapatite in the bones and thus prevent calcium loss from the bones. Bisphosphonates are used in the first-line treatment of osteoporosis caused by hyperparathyroidism.

A positive effect of the drug is a reduction in the incidence of pathological bone fractures. Side effects include an increase in blood pressure or the risk of stomach ulcers.

Surgical management

Surgery, in which parathyroid tissue is removed, is one of the cures for primary hyperparathyroidism in most cases. It is sufficient to remove only the glands that are enlarged or affected by a tumor, such as an adenoma.

If all four glands are affected, only three or three with part of the fourth gland are removed. At least a small amount of functional parathyroid tissue that produces parathyroid hormone is left.

Possible complications and risks of surgery include:

• Damage to the nerves that control the vocal cords. These nerves pass in close proximity to the area in which the surgeon is operating. They can easily be inadvertently damaged. The result is loss of the patient's voice.
• An extreme reduction in calcium levels that requires calcium and vitamin D replacement. This condition occurs due to the removal of all four glands or damage to the small amount of parathyroid tissue that remains. The body can no longer produce enough parathyroid hormone on its own to maintain normal calcium levels.