Primary hyperparathyroidis - When to observe and when to operate

The decision to operate or not on a patient with primary hyperparathyroidism depends on how the disorder presents clinically Symptomatic patients should undergo parathyroid surgery. Asymptomatic patients may or may not be candidates for surgery depending on the presence of features of the disease that may place these patients at increased risk for complications. Recent observations have expanded the potential indications for parathyroid surgery among those who are asymptomatic. This article reviews classic and newer indications for surgery, and presents results of the decision for or against surgery in the context of the natural history of the disease.