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Hyperparathyroidism is overproduction of parathyroid hormone often causing fatigue,body ache, bone pain or sleep disturbance .

Medications:

  • Tab. Lasix 40 (Furosemide 40 mg) 1 tablet once or twice a day for hypercalcemia.
  • Nasal spray Calcinase (Calcitonin 200 IU) – one spray intranasally per day.
  • Tab. Osteofos 70 (Alendronic acid 70 mg) 1 tablet once a week. It may cause severe irritation of oesophagus, hence ask the patient to stay in strict upright position for up to 2 hours after taking the tablet.

General advice:

  • Maintain adequate hydration.
  • Exercise regularly.
  • Avoid high calcium diet but continue a moderate calcium intake.
  • Avoid vitamin D supplements, thiazide diuretics and Lithium.

Investigations:

  • Parathyroid hormone level -To identify raised levels of parathyroid hormone.
  • Serum electrolytes -To rule out or treat low potassium, chloride and magnesium.
  • Creatinine clearance -To look for renal impairment.
  • DEXA scan -To rule out evidence of osteoporosis.
  • USG abdomen -To rule out evidence of renal stones.

Indications for surgery (parathyroidectomy)

  • Serum calcium more than 12 mg/dl inspite of optimum medical therapy
  • Hypercalciuria
  • Osteoporosis
  • Evidence of renal stones and calcification in kidneys
  • Age less than 55 years
  • Neuromuscular disease
  • Creatinine clearance less than 60

Referral:

Consider referral to endocrinologist if patient fails to respond or presents with additional complications.