Brief Answer:
Surgery

Detailed Answer:
I have reviewed the attached reports.

Typically, surgery is recommended for this type of a condition.

The diagnosis appears to be

'Hypercalcemia due to Primary Hyperparathyroidism due to single left parathyroid adenoma'

In non-medical language this simply means that you have high blood calcium levels due to an overactive parathyroid gland in the neck, which is making excessive parathyroid hormone. This also leads to excess calcium in the urine and low phosphorus in the blood.

Most of the time, surgery cures this problem.

There is a medication approved for this called Cinacalcet but in general, surgery is considered the best option provided you are found to be a good candidate for it based on a thorough assessment by your endocrinologist in-person.

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Brief Answer:
Follow up

Detailed Answer:
Hyperparathyroidism is a disorder of the parathyroid glands in your neck. These glands make a hormone that helps control the amount of calcium in the blood. This hormone is called “parathyroid hormone,” or “PTH.”

Hyperparathyroidism is when your parathyroid glands make too much PTH. This causes too much calcium to build up in your blood. Primary hyperparathyroidism, the most common form of hyperparathyroidism, can happen when one or more of the glands get bigger than they should, or when a gland develops an abnormal growth. Cancer is another possible cause of hyperparathyroidism, but this is very rare.

What are the symptoms of hyperparathyroidism? — Most people with this condition have no symptoms. But some people do have symptoms that might be related to having more calcium in their blood than normal. These symptoms include:

●Pain in the joints
●Feeling tired or weak
●Loss of appetite
●Feeling depressed
●Trouble concentrating
If your PTH and blood calcium levels get very high, you might get constipated, feel very thirsty, or urinate more often than usual. Some people have more serious symptoms, such as:

●Problems with how the kidneys work
●Kidney stones
●Weak bones
●Gout (a kind of arthritis) or other problems in the joints
●Chemical imbalances in the blood
“Parathyroid crisis” is a rare but serious problem. It can happen if you have hyperparathyroidism and get sick with something that causes you to lose fluids (like vomiting or diarrhea). This causes the amounts of PTH and calcium in the blood to go up suddenly. If this happens, you might have belly pain, nausea, and sometimes problems thinking clearly and staying alert. It is important to see a doctor or nurse right away if you have hyperparathyroidism plus lasting vomiting or diarrhea, and can't keep fluids down.

Is there a test for hyperparathyroidism? — Yes. A doctor or nurse can tell if you have hyperparathyroidism by measuring the levels of PTH and calcium in your blood. Many people with hyperparathyroidism do not notice any symptoms. The condition is often found when a doctor or nurse does a blood test for some other reason.

If you have hyperparathyroidism, your doctor or nurse might do other tests, too. You will probably get a special kind of X-ray to see if your bones are weaker than normal. Plus, you might get checked for kidney stones, if you have had kidney stones in the past.

Is there anything I can do on my own to help my condition? — Yes. Even if you do not have any symptoms, there are things you can do to help prevent problems:

●Drink plenty of liquids, and try not to get dehydrated. This can help to prevent kidney stones.
●Stay active. This can help keep your calcium levels normal and your bones healthy.
●Try to get about 1000 milligrams of calcium each day. It is better to get your calcium from foods and drinks rather than supplements. But if you aren’t getting enough calcium from the foods you eat, you might need a supplement. Your doctor will let you know.
●Try to get about 400 to 600 international units (IU) of vitamin D each day. Not having enough vitamin D can weaken your bones.
●Do not take certain medicines that can affect the amount of calcium in the blood. Your doctor or nurse can tell you which medicines to avoid.
Even if you feel healthy, your doctor or nurse should still check your blood calcium every 6 months. He or she will also do regular tests to check your kidneys and bones. (People whose bones are weakened because of their condition can get medicines to help protect their bones.)

How is hyperparathyroidism treated? — The main treatment is surgery to remove the gland or glands that are causing the problem. (In most cases, surgery cures the hyperparathyroidism.) Still, people who have no symptoms do not always need surgery.

You will most likely need surgery if:

●The amount of calcium in your blood is much higher than normal;
●Your hyperparathyroidism is causing problems with your kidneys or bones;
●You are younger than 50; or
●You are not able to get regular checkups and tests.

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Brief Answer:
Second follow up

Detailed Answer:
After surgery, you will require specialised management both in the hospital and in the days to come.

An endocrinologist will need to keep an eye on your calcium levels because they can drop temporarily as the other parathyroids gradually wake up. Initially some medications such as calcium supplements may be required which will slowly be withdrawn based on regular blood calcium checks.

Then one has to look out for the other potential complications of the surgery which are infrequent in experienced hands, such as

Nerve injury

Bleeding/clot formation ('hematoma')

These are only the main examples. You will need to discuss the surgery related care in detail with your surgeon too.

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Brief Answer:
Third follow up

Detailed Answer:
You will likely need calcium supplementation for some time after surgery. The exact doses and duration of treatment with calcium will be determined by your endocrinologist by regular blood test monitoring.

There is nothing in particular you need to avoid in terms of diet after surgery.

If I were you I would not delay surgery. It would not be a good idea to do so. However, if you must then discuss this with your endocrinologist

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