Although most patients with parathyroid disorders undergo surgical treatment, some patients may have conditions that are not treatable with a parathyroidectomy. This includes people with hypoparathyroidism (underproduction of parathyroid hormone) and certain people with hyperparathyroidism who are not candidates for surgery, such as someone not displaying any symptoms. In these cases, physicians may recommend certain medications to control symptoms of the disorder and avoid potential complications such as hypercalcemia or hypocalcemia (too little calcium in the blood).

Recommendations for people with asymptomatic hyperparathyroidism who chose to forgo surgical treatment include:

• Avoid thiazide diuretics and lithium medications, prolonged bed rest and diets that are high in calcium
  
  
• Be physically active
  
  
• Drink enough fluid and avoid dehydration
  
  
• Consume moderate amounts of calcium and vitamin D
  
  
• Have tests every six months to a year for bone loss and kidney damage

Medications may be used to treat cases of asymptomatic or mild hyperparathyroidism. They do not cure the condition, but reduce its severity. Some medications that may be prescribed in these cases include:

• Calcimimetics. Medications that trigger the parathyroid glands to stop secreting parathyroid hormone (PTH). The Food and Drug Administration (FDA) has approved them only for primary hyperparathyroidism due to parathyroid cancer and secondary hyperparathyroidism occurring with kidney failure being treated with dialysis. They may not be suitable for use in patients with liver disease.
  
  
• Bisphosphonates. Medications used to reduce and help reverse osteopenia (loss of bone density) and osteoporosis. Their effectiveness in treating patients with hyperparathyroidism is still being studied and they may not be suitable for people with kidney problems or women who are pregnant.
  
  
• Estrogen and progestin. Hormones that help reduce bone loss for postmenopausal women. These hormones are typically not recommended because of the associated significant risks of breast cancer, stroke and heart disease.
  

  

Extremely high levels of calcium in the blood may lead to a parathyroid crisis, which can lead to coma. Treatment of a parathyroid crisis requires intravenous fluid administration to reduce the amount of calcium and possibly dialysis. In this case, a parathyroidectomy will likely be necessary.

Treatment for hypoparathyroidism is focused on maintaining normal levels of calcium in the body through the use of medication. There is no surgical option for this condition. Patients with hypoparathyroidism usually require supplements of calcium and vitamin D. These supplements are taken for the rest of the patient’s life to maintain adequate levels of calcium in the bloodstream.

Calcium carbonate is the form of calcium most often used as a supplement. However, absorption of calcium carbonate may be difficult for older patients and those who do not produce much acid in their stomachs. For these people, other forms of calcium, such as calcium citrate and calcium glutamate, are available that may be easier to become absorbed into the body. Some types of calcium supplements may be unsuitable for patients with kidney failure.

Vitamin D or calcitrol (a form of vitamin D) is sometimes also used because it helps the intestines absorb calcium from food and supplements. In addition, patients may be prescribed thiazide diuretics to reduce the amount of calcium that a patient excretes in urine. This reduces the risk of a buildup of calcium in the body, which may lead to hypercalcemia.

Additionally, patients with hypoparathyroidism should consume a diet that is high in calcium and includes foods such as dairy products, certain types of beans, and green, leafy vegetables.