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.