Medical Treatment of Hyperparathyroidism

• Hyperthyroidism will typically only need to be treated in the Emergency Department when they present with Hypercalcemia. 
• Outpatient management of hyperthyroidism consists of serial PTH measurements, Calcium, and Creatinine.
• Hypercalcemia should be treated with normal saline hydration. 
  • Once the patient is determined to be euvolemic you can enhance diuresis and excretion of calcium by giving the patient furosemide. 
  • Remember hydrochlorathiazide can actually increase serum calcium by preventing its excretion.
  • This patients should receive 4-10 liters of normal saline in the first day.
  • You can also give bisphosphonates and calcitonin. 
  • For high calcium levels with mental status changes consider hemodialysis.