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Hyperthyroidism |
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Multiphasic screening tests are identifying approximately 100,000 new cases of hyperparathyroidism (HPT) each year in the U.S., according to a panel of experts convened by the National Institutes of Health. Because many of these patients show no overt symptoms of the disease, there is controversy over how to treat them. Although surgery remains the only treatment for HPT, the panel said there is a small group of asymptomatic patients that may not require immediate treatment. Because it is currently impossible to predict who will develop symptoms and long-term complications of the disease, the experts urge that asymptomatic patients not recommended for surgery be closely monitored for signs of disease progression. The choice between surgery and medical management should be ”founded on clinical judgement on a case-by-case basis,’ according to Dr. John Potts, physician-in-chief at Massachusetts General Hospital and panel chairman. The risk of hyperparathyroidism increases with age and occurs most often in postmenopausal women. Usually, a benign tumor on one of the four parathyroid glands in the neck causes high levels of calcium and parathyroid hormone. Potential complications range from bone loss with potential fractures and kidney problems, to fatigue, weakness, depression, and other common symptoms. The panel said that removal of the tumor by an experienced endocrine surgeon cures the disease in 95% of cases. When surgery is not elected, the panel recommended semi-annual tests to monitor patients for significant increases in calcium levels, deterioration of kidney function, and development of kidney stones; bone mass should also be assessed. Once stability is established in 1 to 3 years, intervals for followup visits can be increased. The experts also recommended these patients drink lots of water, get plenty of exercise, and avoid diuretics. The panel recommended against the use of expensive imaging techniques to locate benign tumors prior to initial surgery. Evidence indicates that such tests do not improve the success of surgical therapy and are not cost effective. These tests may be useful, however, if a previous operation failed. Finally, the panel called for a randomized, multicenter clinical trial to compare surgical versus medical management of HPT and for additional basic research to develop pharmacologic therapy for the disease. This 3-day Consensus Development Conference was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases and the NIH Office of Medical Applications of Research.
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