Individual research recommendation details

Recommendation ID

NG132/3

Question

What are the long-term outcomes of different management strategies for primary hyperparathyroidism? Which strategies are most cost effective?

Any explanatory notes
(if applicable)

People who have had successful parathyroid surgery

Based on their knowledge and experience, the committee agreed that the risk of recurrent disease after successful parathyroid surgery is very low and therefore it is sufficient to monitor albumin-adjusted serum calcium levels once a year.

For people who have osteoporosis, although bone density improves after surgery, skeletal recovery can take some time and needs specialist monitoring. The risk of renal stones decreases after successful surgery, but the residual risk persists and the committee agreed that specialist opinion on monitoring should be sought.

People who have not had parathyroid surgery, or whose surgery has not been successful

Based on their clinical experience, the committee agreed that monitoring for people who have had unsuccessful surgery should be the same as for people who have had no previous surgery. Monitoring bridges the gap between first surgery and multidisciplinary review and reassessment in a specialist centre.

The committee noted the increased risk of renal stones and fractures in people who have had unsuccessful or no parathyroid surgery. Evidence suggests that around one‑third of people who do not have symptoms or indications for surgery will go on to develop these. The committee agreed that monitoring will ensure that surgery, including repeat surgery, can be offered when needed.

People who have had parathyroid surgery for multigland disease, or have disease that recurs after successful surgery

The committee agreed that people with multigland disease, or disease that has recurred after successful surgery, have a slightly increased risk of future recurrence and will benefit from specialist endocrine opinion on monitoring.

All people with primary hyperparathyroidism

For all people with primary hyperparathyroidism, the committee agreed that there was no evidence to suggest that surgery modifies cardiovascular disease risk or fracture risk, so these should be assessed in line with NICE guidance.

The committee noted the limited evidence on long-term outcomes and made a research recommendation.

How the recommendations might affect practice

The recommendations reflect current practice in most NHS centres, so the committee expects little change in practice.

Full details of the evidence and the committee's discussion are in evidence review F: management options in failed primary surgery and evidence review I: monitoring.

Source guidance details

Comes from guidance

Hyperparathyroidism (primary): diagnosis, assessment and initial management

Number

NG132

Date issued

May 2019

Other details