Editing Parathyroidectomy (section)

==Indications==
The main indication for parathyroidectomy is primary hyperparathyroidism, a condition in which one or more of the parathyroid glands produce excessive parathyroid hormone. Not all cases of primary hyperparathyroidism require surgery, but it is recommended if the condition causes significant symptoms or if it affects the kidneys ([[nephrocalcinosis]]) or bone health ([[osteoporosis]]), and also in people under 50 even if they do not have symptoms.<ref name=AAES>{{cite journal |last1=Wilhelm |first1=Scott M. |last2=Wang |first2=Tracy S. |last3=Ruan |first3=Daniel T. |last4=Lee |first4=James A. |last5=Asa |first5=Sylvia L. |last6=Duh |first6=Quan-Yang |last7=Doherty |first7=Gerard M. |last8=Herrera |first8=Miguel F. |last9=Pasieka |first9=Janice L. |last10=Perrier |first10=Nancy D. |last11=Silverberg |first11=Shonni J. |last12=Solórzano |first12=Carmen C. |last13=Sturgeon |first13=Cord |last14=Tublin |first14=Mitchell E. |last15=Udelsman |first15=Robert |last16=Carty |first16=Sally E. |title=The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism |journal=JAMA Surgery |date=1 October 2016 |volume=151 |issue=10 |pages=959–968 |doi=10.1001/jamasurg.2016.2310 |pmid=27532368|s2cid=4007319 }}</ref> It is not always possible to anticipate if a parathyroid tumor is [[cancer|malignant]] (i.e. capable of invading other tissues or [[metastasis|spreading elsewhere]]). Any suspicion of parathyroid carcinoma is therefore also an indication for surgery.<ref name=AAES/>

Parathyroidectomy may also be required in secondary hyperparathyroidism. This situation arises mainly in people with severe [[chronic kidney disease]] in which the parathyroid glands are overactive to compensate for the low calcium and vitamin D levels often present in CKD. In many cases, the parathyroid hormone production improves when these abnormalities are treated with medication. A small proportion, however, have persistently raised hormone levels six months after treatment has started, thought to be autonomous production of hormone by the glands and loss of feedback mechanisms. In this situation surgical parathyroidectomy may be required, especially if calcium and phosphate levels remain elevated, there is calcium deposition in the wall of blood vessels ([[calciphylaxis]] in severe cases) or there is worsening bone disease. In people on [[Kidney dialysis|dialysis]], parathyroidectomy can improve their survival. It does appear that the procedure may be underused.<ref name=Lau2018>{{cite journal |last1=Lau |first1=WL |last2=Obi |first2=Y |last3=Kalantar-Zadeh |first3=K |title=Parathyroidectomy in the Management of Secondary Hyperparathyroidism |journal=Clinical Journal of the American Society of Nephrology |date=7 June 2018 |volume=13 |issue=6 |pages=952–961 |doi=10.2215/CJN.10390917 |pmid=29523679|pmc=5989682 }}</ref>