Concentration of serum calcium is not correlated with symptoms or severity of primary hyperparathyroidism: An examination of 20,081 consecutive adults

Surgery. 2017 Jan;161(1):98-106. doi: 10.1016/j.surg.2016.09.012. Epub 2016 Nov 15.


Background: Guidelines for operative treatment of primary hyperparathyroidism include calcium levels >1 mg/dL above normal. We sought to determine whether greater calcium concentrations were associated with increased symptoms or disease severity.

Methods: A retrospective review of a prospectively maintained database of adults undergoing parathyroidectomy for primary hyperparathyroidism, grouped according to greatest preoperative calcium level: those patients with calcium concentrations between 10.0 and 11.0 mg/dL and those with >11.0 mg/dL. We compared subjective symptoms and objective measures of disease severity.

Results: The review included 20,081 adults who were split nearly evenly between calcium concentrations between 10.0 and 11.0 (10,430, 51.9%) and those with >11.0 mg/dL (9,651, 48.1%). In both groups, an absence of symptoms related to primary hyperparathyroidism was uncommon (<5%). All subjective and objective measures of disease severity were nearly identical with no significant differences (percentages for calcium concentrations between 10.0 and 11.0 and those with >11.0 mg/dL, respectively), including fatigue (72% for both groups), heartburn (37% vs 34%), bone pain (50% vs 48%), sleep disturbances (68% vs 65%), osteoporosis (40% in both groups), kidney stones (21% vs 22%), chronic kidney disease with glomerular filtration rate <60 (29% vs 32%), and hypertension (50% vs 53%).

Conclusion: Serum calcium concentrations of greater than or less than 11 mg/dL are unrelated to symptoms and disease severity in primary hyperparathyroidism. There is no evidence to support a serum calcium threshold in parathyroidectomy guidelines.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Biomarkers / blood
  • Calcium / blood*
  • Cohort Studies
  • Databases, Factual
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperparathyroidism, Primary / blood*
  • Hyperparathyroidism, Primary / physiopathology
  • Hyperparathyroidism, Primary / surgery*
  • Male
  • Middle Aged
  • Parathyroid Hormone / blood
  • Parathyroidectomy / methods
  • Preoperative Care / methods
  • ROC Curve
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome


  • Biomarkers
  • Parathyroid Hormone
  • Calcium