Primary Hyperparathyroidism Post Parathyroidectomy
Discharge Criteria from Endocrinology:
1. Calcium and PTH level are normal for at least 1 year post-operatively
2. In patients with known osteoporosis or a high 10-year fracture risk, a 1-year post-parathyroidectomy BMD should be stable/improving
3. No new non-traumatic fracture or kidney stones, with stable/improving eGFR
4. Genetic testing has been conducted/considered for those with multigland parathyroid disease or presentation with primary hyperparathyroidism < 40 years of age or parathyroid carcinoma.
Normocalcemic Primary Hyperparathyroidism:
1. Other causes of secondary hyperparathyroidism have been excluded
2. Total calcium and ionized calcium levels are normal with an elevated PTH twice 3-6 months apart
3. There are no end-organ manifestations of the condition:
a. BMD T-score better than --2.5 at 3 sites (including the 33% radius), no vertebral compression fracture, and no history of non-traumatic fracture
b. eGFR normal with no history/imaging findings of kidney stones or hypercalciuria
Topic Expert Review: Jesse Pasternak (Urology), Robert Josse (Endocrinologist)
Primary Care Review: Dr Curtis Handford, DFCM, St Michael's Hospital
Plain Language Review: Katrina Grieve, St Michael's Hospital
Reference:
1. Bilezikian JP, Khan AA, Silverberg SJ, Fuleihan GE, Marcocci C, Minisola S, Perrier N, Sitges-Serra A, Thakker RV, Guyatt G, Mannstadt M, Potts JT, Clarke BL, Brandi ML; International Workshop on Primary Hyperparathyroidism. Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop. J Bone Miner Res. 2022 Nov;37(11):2293-2314. doi: 10.1002/jbmr.4677. Epub 2022 Oct 17. PMID: 36245251.
