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Dr. Andrew Rynne

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Suggest treatment for hypercalcemia

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Dr. Mirjeta Guni

Endocrinologist

Practicing since :2006

Answered : 2021 Questions

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Posted on Wed, 15 Mar 2017 in Thyroid Problem and Hormonal Problems
Question: I have but one parathyroid left (after total thyroidectomy) and I have hyperparathyroidism PTH at 80, but also within normal range. Hypercalcemia (2.71) and serious osteoporosis (-3.9). Was operated in 2001 for primary hyperparathyroidism (adenoma), whole thyroid was removed because of a cancerous (papillary-follicular) nodule. Had XXXXXXX (150 mC, in total). I feel bad, also mentally.
What should I do? Have the one remaining parathyroid removed? But that will create other problems. I have no clue, I feel it is like choosing between the pest and the cholera. I have surfed masses, but there is no medicinal cure for primary parathyroidism. Resection seems to be the solution, but that to me is not really solving the problem, but rather exchanging it for another problem. Thank you for your advice, it is valuable to me! Ines from Belgium.
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Answered by Dr. Mirjeta Guni 32 minutes later
Brief Answer:
About hypercalcemia treatment;

Detailed Answer:
Hello dear Ines and thank you for asking!
I have gone through your concern carefully and understood your query.

Your problem is being faced very often in our everyday practice.
Usually Sestamibi visualizes one enlarged parathyroid gland that is removed successfully by the surgeon, but in 10% of cases there is also another parathyroid gland enlarged, secreting PTH too.

This is diagnosed intra-operatively by checking directly the hormone production by each parathyroid gland and removing all the overproducing parathyroids, avoiding a second surgery.

As you may know, depression and osteoporosis are side effects of high calcium level and are criteria for recommending a second intervention.

But i would recommend to do it in a specialized center.

If surgery is refused, bisphosfonates or calcimimetics would be the next line of treatment of hypercalcemia.

Hope the information will help. Feel free to ask further.
Kind regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Mirjeta Guni 23 minutes later
Biphosphonates do not help for primary hyperparathyroidism. There is a lot of information on that on the website: parathyroid.com

Is it possible to live without parathyroids? What quality of life is there? Take lots of pills a day? I think there is no solution to this.

Calcimimetics are not used for primary parathyroidism, are they?

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Answered by Dr. Mirjeta Guni 14 minutes later
Brief Answer:
Hyperparathyroidism treatment;

Detailed Answer:
Welcome back!

If surgery is not indicated ( as only one parathyroid is left), medication treatment is the only way of treatment and consists in using bisphosfonates or calcimimetics, of course without the efficiency of surgical removal of adenoma.

Yes, you're correct that they do not treat hyperparathyroidism but osteoporosis and high calcium levels caused by it.


Best wishes,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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