Secondary hyperparathyroidism (SHP) is a condition that develops from chronic stimulation of the parathyroid glands by low calcium levels. This most commonly occurs in patients with low vitamin D levels and in patients with renal failure. The best treatment of SHP is to correct the underlying problem. Patients with vitamin D deficiency require supplementation to replenish stores, while SHP in patients with renal failure can only be corrected with a kidney transplant. When transplantation is not possible, patients are treated medically with phosphate binders and calcimimetic drugs like Sensipar.
In some patients, these medical maneuvers may fail to safely control the disease putting the patient in danger of calciphylaxis, which is the painful deposition of calcium in the skin and muscles. Signs that medical management may be failing include sustained PTH levels greater than 800 pg/mL, uncontrolled itching, deteriorating bone density and inability to control calcium and phosphate levels with dialysis.
When patients fail medical therapy, surgery to reduce the amount of parathyroid tissue should be considered. The operation is tailored to the individual needs of the patient. This usually means removing 3 or 3 ½ of the parathyroid glands to achieve a postoperative PTH level of between 200 and 300 pg/mL.