For which patients with calciphylaxis would you recommend a parathyroidectomy?

In those with refractory hyperparathyroidism (typically PTH above 800-1000 pg/mL) despite medical therapies like cinacalcet.

In patients with refractory elevated PTH that is not responding to the medical therapy. Having calciphylaxis adds to the indication.

I would recommend parathyroidectomy in patients with significantly elevated PTH (> 1500-2000?) that does not get controlled with medical management for at least one year. Having had calciphylaxis make it even more important and urgent to go ahead with it.

It’s too late to treat medically first!