Do I need surgery if I don't have symptoms? I am a 65 year old woman who was recently diagnosed with primary hyperparathyroidism. My calcium and PTH levels are both high. I have osteoporosis, but have not had any fractures, and otherwise I am very healthy. I don't have any of the symptoms that other people report. If I feel pretty good overall, do I really need the operation?
This is a great question. It’s odd to hear that you might need an operation for something that isn’t really bothering you. In cases of clear primary hyperparathyroidism, I do usually end up recommending surgery. We know that the disease does not go away on its own. And we know that the symptoms and the complications from parathyroid disease get worse with time. It is actually pretty common for a patient to tell me that she had no symptoms for the first few years of high calciums. Eventually, most people develop symptoms, but it may take a few years. And many patients are having symptoms but do not realize that they are related to their parathyroids. The most common symptoms are fatigue, brain fog, and difficulty sleeping through the night. Many people just assume they are getting older, and many women assume it is just menopause. These are symptoms of primary hyperparathyroidism, though, and they will get better after surgery.
You also mentioned that you have osteoporosis. While your osteoporosis may have been initiated by other factors, having parathyroid disease is not going to help your bones. We know that over time, people with untreated parathyroid tumors tend to have worsening bone loss. Getting surgery for parathyroid disease is not going to give someone the bones of a 30 year old, but it will decrease the risk of fracture.
There are also other complications of primary hyperparathyroidism that can occur over time, such as chronic kidney disease (even if you do not get kidney stones), gastric reflux, and cardiac arrhythmias. Treating the disease (getting the tumor removed) will prevent these from occurring.
For patients with primary hyperparathyroidism, the potential benefits almost always outweigh the potential risks. The risks are very low, and the potential benefit to overall health is generally large. Even if you don’t feel bad, primary hyperparathyroidism can cause damage over time. This is why I usually recommend an operation, even for someone who reports feeling well.