title: Thiazide Treatment in Primary Hyperparathyroidism-A New Indication for an Old Medication?
abstract: There is no therapy for control of hypercalciuria in nonoperable patients with primary hyperparathyroidism (PHPT). Thiazides are used for idiopathic hypercalciuria but are avoided in PHPT to prevent exacerbating hypercalcemia. Nevertheless, several reports suggested that thiazides may be safe in patients with PHPT.
  
  
  
  To test the safety and efficacy of thiazides in PHPT.
  
  
  
  Retrospective analysis of medical records.
  
  
  
  Endocrine clinic at a tertiary hospital.
  
  
  
  Fourteen male and 58 female patients with PHPT treated with thiazides.
  
  
  
  Data were compared for each patient before and after thiazide administration.
  
  
  
  Effect of thiazide on urine and serum calcium levels.
  
  
  
  Data are given as mean ± standard deviation. Treatment with hydrochlorothiazide 12.5 to 50 mg/d led to a decrease in mean levels of urine calcium (427 ± 174 mg/d to 251 ± 114 mg/d; P < 0.001) and parathyroid hormone (115 ± 57 ng/L to 74 ± 36 ng/L; P < 0.001), with no change in serum calcium level (10.7 ± 0.4 mg/dL off treatment, 10.5 ± 1.2 mg/dL on treatment, P = 0.4). Findings were consistent over all doses, with no difference in the extent of reduction in urine calcium level or change in serum calcium level by thiazide dose.
  
  
  
  Thiazides may be effective even at a dose of 12.5 mg/d and safe at doses of up to 50 mg/d for controlling hypercalciuria in patients with PHPT and may have an advantage in decreasing serum parathyroid hormone level. However, careful monitoring for hypercalcemia is required.
authors.affiliation: Institute of Endocrinology, Diabetes and Metabolism, and.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978 Israel.
authors.forename: Gloria
authors.initials: G
authors.lastname: Tsvetov
authors.affiliation: Institute of Endocrinology, Diabetes and Metabolism, and.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978 Israel.
authors.forename: Dania
authors.initials: D
authors.lastname: Hirsch
authors.affiliation: Institute of Endocrinology, Diabetes and Metabolism, and.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978 Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Shimon
authors.affiliation: Institute of Endocrinology, Diabetes and Metabolism, and.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978 Israel.
authors.forename: Carlos
authors.initials: C
authors.lastname: Benbassat
authors.affiliation: Institute of Endocrinology, Diabetes and Metabolism, and.
authors.forename: Hiba
authors.initials: H
authors.lastname: Masri-Iraqi
authors.affiliation: Institute of Endocrinology, Diabetes and Metabolism, and.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978 Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gorshtein
authors.affiliation: Institute of Endocrinology, Diabetes and Metabolism, and.
authors.forename: Dana
authors.initials: D
authors.lastname: Herzberg
authors.affiliation: Statistical Consulting Unit, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492 Israel.
authors.forename: Tzippy
authors.initials: T
authors.lastname: Shochat
authors.affiliation: Institute of Endocrinology, Diabetes and Metabolism, and.
authors.forename: Ilana
authors.initials: I
authors.lastname: Shraga-Slutzky
authors.affiliation: Institute of Endocrinology, Diabetes and Metabolism, and.
authors.forename: Talia
authors.initials: T
authors.lastname: Diker-Cohen
mesh_terms: D000368:Aged; D002118:Calcium / Q000097:blood / Q000378:metabolism* / Q000652:urine; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000627:therapeutic use*; D006934:Hypercalcemia / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D006961:Hyperparathyroidism / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000652:urine; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D010281:Parathyroid Hormone; D006852:Hydrochlorothiazide; D002118:Calcium