Table 2

Indications for surgery in asymptomatic PHPT (2013)47

Indications for surgery in asymptomatic PHPT
Serum calcium>0.25 mmol/L above the upper limit of normal
BoneBMD by DXA: T-score (or Z-score if age<50 years)<−2.5 at lumbar spine, total hip, femoral neck or distal 1/3 radius
Vertebral fracture by x-ray, CT, MRI or VFA*
RenalCreatinine clearance <60 mL/min†
24 hours urine for calcium>400 mg/day and increased stone risk by biochemical analysis†
Presence of nephrolithiasis or nephrocalcinosis by x-ray, ultrasound or CT
Age<50 years
  • Patients need to meet only one criterion for consideration of surgery.

  • *A history of fragility fracture at any site would define symptomatic PHPT and the patient would be automatically considered a surgical candidate.

  • †Chronic kidney disease and hypercalciuria are not relevant as these patients strictly speaking do not have NPHPT. BMD, bone mineral density; DXA, dual-energy x-ray absorptiometry; NPHPT, normocalcaemic primary hyperparathyroidism; VFA, vertebral fracture assessment.