Does Mild, Asymptomatic Hyperparathyroidism Require Surgery?

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Abstract
Mild, asymptomatic primary hyperparathyroidism now poses the problem of therapy that mild hypertension once did — we do not know which is more dangerous, parathyroidectomy or the untreated disease itself, when serum calcium is less than 11 mg per deciliter, and nephrolithiasis, osteitis fibrosa, peptic ulcer, pancreatitis, and azotemia are absent. Purnell and his colleagues1 left 141 such patients untreated for five years. Twenty-seven were lost to follow-up, and six died of unrelated illnesses, but of the 108 left for analysis, 87 remained well. Parathyroidectomy was required because of declining renal function in five, hypercalcemia above 11 mg per deciliter . . .