Primary Hyperparathyroidism · Observe vs Parathyroidectomy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Symptoms + surgical criteria
   Symptomatic? Meets surgical criteria? (Surgical criteria (any): serum calcium >ULN + 1.0 mg/dL (0.25 mmol/L); age <50; eGFR <60; 24-h urine calcium >400 mg + increased stone risk; imaging shows nephrolithiasis/nephrocalcinosis; T-score ≤−2.5 or vertebral fracture.)
   • Symptomatic (kidney stones, fragility fracture, marked hypercalcemia symptoms) → Parathyroidectomy
   • Asymptomatic but meets any surgical criterion → Parathyroidectomy
   • Asymptomatic, criteria not met, or unable/unwilling to have surgery → Monitor ± medical
2. [End] Parathyroidectomy
   Parathyroidectomy (~95% cure): if preoperative localization (neck ultrasound + sestamibi) concordantly indicates a single adenoma → minimally invasive/focused excision + intraoperative PTH monitoring; discordant localization/multigland hyperplasia/familial or MEN → bilateral neck exploration. Monitor calcium and vitamin D postoperatively.
3. [End] Monitor ± medical
   Asymptomatic not meeting criteria or unfit for surgery → monitor (serum calcium, renal function, bone density periodically) ± medical: cinacalcet to control calcium, bisphosphonate/denosumab for bone protection; ensure hydration, avoid dehydration and thiazide diuretics.

Source guidelines & references

• Primary hyperparathyroidism evaluation and surgical indications (2022 Fifth International Workshop; AAES guideline)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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