The risk of recurrent hyperparathyroidism is greatest for patients who present with either multiple endocrine adenomatosis type I or familial hyperparathyroidism. Because of the difficulty in establishing a histologic diagnosis of parathyroid cancer at the time of initial surgery, the appearance of recurrent or metastatic tumor can be the first sign of malignancy. Subtotal thyroidectomy has been advocated for patients with more than one involved gland or with diffuse hyperplasia. The major morbidity of recurrent or metastatic parathyroid cancer results from severe hypercalcemia, which can be difficult to control. However, control of malignant hypercalcemia with these medical measures is often only temporary.
Anecdotal reports show that short-term remissions with chemotherapy are possible.
As parathyroid carcinoma can be slow-growing, resection of local recurrences or distant metastases can bring effective palliation but rarely cure. Medical management of hypercalcemia. Surgery plus radiation therapy. Disodium pamidronate in the preoperative treatment of hypercalcemia in patients with primary hyperparathyroidism. Warrell RP, Israel R, Frisone M, et al.