Recommended thresholds for consideration of parathryoidectomy in management of asymptomatic PHPT
| Parameter | Threshold for recommending surgery |
|---|---|
| Serum adjusted calcium | 0.25 mmol/L > upper limit of reference range |
| Bone mineral density | T score < –2.5 at lumbar spine, total hip, femoral neck or distal 1/3 radius |
| Vertebral morphometry | Presence of vertebral fracture detected by X-ray, CT, MRI or VFA |
| Creatinine clearance | eGFR <60 mL/min/1.73m 2 |
| 24-hour urine calcium excretion | >10 mmol/day by 24 hour urine analysis and increased stone risk by biochemical stone risk analysis |
| Renal imaging | Presence of nephrolithiasis or nephrocalcinosis on X-ray, USS or CT |
| Age | <50 years |
Thresholds given are according to consensus statement of fourth international workshop on management of asymptomatic primary hyperparathyroidism.13 Patients need only meet one of the above criteria for parathyroidectomy to be indicated. CT = computerised tomography; eGFR = estimated glomerular filtration rate; MRI = magnetic resonance imaging; USS = ultrasound scan; VFA = vertebral fracture assessment.