TABLE 1

International criteria for parathyroid surgery in patients with primary hyperparathyroidism

Surgery is recommended in all patients with at least 1 of the following:

  • Serum calcium > 1.0 mg/dL (0.25 mmol/L) above the upper limit of normal

  • Bone mineral density by dual-energy x-ray absorptiometry: T-score ≤ −2.5 at lumbar spine, total hip, femoral neck, or distal one-third radius

  • Vertebral fracture by radiography, computed tomography, or magnetic resonance imaging

  • Estimated glomerular filtration rate or creatinine clearance < 60 mL/minute

  • 24-hour urine calcium level > 250 mg in women and > 300 mg in men

  • Presence of nephrolithiasis or nephrocalcinosis by radiography, ultrasonography, or computed tomography

  • Age < 50

  • Based on information in reference 2.