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Parathyroid Carcinoma Treatment & Management

  • Author: Lawrence Kim, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
Updated: Dec 01, 2015

Medical Care

No effective medical therapy for parathyroid carcinoma is known.[7] Trials of chemotherapeutic agents have been generally disappointing with only anecdotal reports of success. This tumor is sufficiently rare that controlled trials are impossible.

Medical therapy is primarily geared toward management of the hypercalcemia that is often quite severe. Treatment is similar to hypercalcemia due to other causes. At initial presentation and for rapid treatment of severe hypercalcemia volume loading and diuresis with a calcium-wasting loop diuretic is the treatment of choice. The next line of therapy, used for chronic treatment, is the bisphosphonates. Detailed dosing information can be found below.

Hypercalcemia due to parathyroid cancer is often resistant to long-term medical management and is usually the cause of death in patients with metastatic disease.


Surgical Care

At present, resection of the parathyroid cancer is the only effective treatment.

  • Preoperative care
    • Because the hypercalcemia caused by parathyroid cancer is often severe, preoperative medical intervention to control hypercalcemia is often required.
    • Volume expansion with isotonic saline and diuresis with furosemide is often adequate.
    • Take care to ensure that any volume contraction is corrected before the operation.
  • Operative management
    • The goal of the initial operation is to remove the tumor en bloc with any adherent tissue, the ipsilateral thyroid lobe, and any enlarged lymph nodes.
    • Because the diagnosis of malignancy is usually uncertain before the operation, the initial approach is the same as for benign primary hyperparathyroidism.
    • Make a standard collar incision. While approaching the parathyroid, be alert for evidence of invasion into surrounding tissue or gland firmness that might indicate malignancy.
    • If any indication of malignancy is noted, perform an en bloc excision as described above.
    • Regional lymph node metastases are uncommon[31] ; however, if any regional lymph nodes are enlarged, perform a compartmental lymphadenectomy.
    • Recommendations on the precise extent of the dissection cannot be made because of the rarity of this condition, but an en bloc excision with negative margins and removal of the involved lymph nodes is standard.
  • Postoperative care
    • Postoperative care is generally the same as for benign hyperparathyroidism.
    • Bone hunger may be quite profound and require substantial doses of postoperative calcium.
  • Resection of recurrence
    • Reoperation for local and regional recurrence is indicated and may provide substantial palliation from hypercalcemia, in some cases for many years.
    • Resection or ablation of pulmonary or hepatic metastases also may provide palliation.
    • Long-term cure after a recurrence is virtually unknown.


See the list below:

  • Experienced surgeon - Surgical removal is the mainstay of treatment.
  • Medical endocrinologist - Medical care of the hypercalcemia can be difficult and complex.
  • Interventional radiologist - Percutaneous ablation or embolization of metastatic lesions may provide palliation.
  • Radiation oncologist - External beam radiation therapy (EBRT) is controversial. It may decrease local recurrence when used in the adjuvant setting postoperatively but the evidence for this is not strong.[8] It may also be used in specific circumstances for treatment of a metastasis. In general, however, parathyroid carcinoma is relatively resistant to radiation therapy.
Contributor Information and Disclosures

Lawrence Kim, MD Professor, Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill School of Medicine

Lawrence Kim, MD is a member of the following medical societies: Association for Academic Surgery, Association of VA Surgeons, International Association of Endocrine Surgeons, Society of Surgical Oncology, Society of University Surgeons, American Association of Clinical Endocrinologists, American Association of Endocrine Surgeons, American College of Surgeons, Southwestern Surgical Congress

Disclosure: Received income in an amount equal to or greater than $250 from: Affinergy, LLC.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jules E Harris, MD, FACP, FRCPC Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD, FACP, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Society of Hematology, Central Society for Clinical and Translational Research, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Additional Contributors

Sanjiv S Agarwala, MD Chief of Oncology and Hematology, St Luke's Cancer Center, St Luke's Hospital and Health Network; Professor, Temple University Shool of Medicine

Sanjiv S Agarwala, MD is a member of the following medical societies: American Association for Cancer Research, American Head and Neck Society, European Society for Medical Oncology, American Society of Clinical Oncology, Eastern Cooperative Oncology Group

Disclosure: Received honoraria from BMS for speaking and teaching; Received consulting fee from Novartis for consulting; Received consulting fee from Merck for consulting.


Wendy Hu, MD Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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Photomicrograph of parathyroid carcinoma showing typical fibrotic septae. Histologic diagnosis can be difficult.
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