Hyperparathyroidism in Emergency Medicine Follow-up

Updated: Oct 13, 2021
  • Author: Philip N Salen, MD; Chief Editor: Erik D Schraga, MD  more...
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Follow-up

Further Outpatient Care

Calcium levels must be periodically monitored for several months postparathyroidectomy.

If calcium levels begin to rise postoperatively, the patient needs to be evaluated for possible accessory parathyroid glands.

Monitor asymptomatic patients for worsening hypercalcemia, deteriorating bone density or renal function, and other complications of hyperparathyroidism.

If the serum calcium concentration falls below 8 mg/dL postparathyroidectomy with a concomitant rise in serum phosphate level, consider the possibility of postsurgical hypoparathyroidism.

Untreated mild hyperparathyroidism is not associated with rapid bone loss at any of the commonly measured skeletal sites: femur, forearm, and lumbar spine. Therefore, while periodic monitoring of bone mineral density in patients with primary hyperparathyroidism is recommended, doing so every 1–2 years is unnecessary since several years of follow-up are required for the decline in the average patient’s bone mineral density to surpass the smallest detectable change. [12]

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Further Inpatient Care

Admit patients with significant symptoms due to hyperparathyroid-induced hypercalcemia and substantial elevations of calcium levels.

Patients who are markedly symptomatic or those with significant electrolyte disturbances should be evaluated by endocrinologists and surgeons experienced in parathyroid removal.

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Deterrence/Prevention

Although patients should refrain from the ingestion of more calcium than is recommended for adults (1200-1500 mg/d), the calcium intake should not be excessively restricted (to < 750 mg/d) because calcium-poor diets may promote processes associated with excessive secretion of parathyroid hormone (PTH).

Because many patients with asymptomatic primary hyperparathyroidism have levels of 25-hydroxyvitamin D that are at the lower end of the reference range or frankly low, the addition of a low level of supplementation achievable with a multivitamin (400 IU of vitamin D daily) is advisable.

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