Clinical characteristics and depression score response after parathyroidectomy in primary hyperparathyroidism

Abstract

Objective Several studies indicate that patients with primary hyperparathyroidism (PHPT) undergoing parathyroid surgery have improvement in mood and neuropsychological functioning. The current analysis aims to examine the relationship between biochemical and clinical variables and the improvement in depression scores and in specific symptoms, after parathyroidectomy. Design A prospective observational case‐control study at a referral centre. Patients Patients with PHPT undergoing parathyroidectomy (n = 88) or thyroid surgery (n = 85). Measurements The Patient Health Questionnaire‐9 (PHQ‐9) was utilized to obtain depression scores at enrolment and 12 months after surgery. The changes in PHQ‐9 were analysed and correlated with baseline clinical and biochemical parameters. Results At enrolment, there was no difference between the groups in the number with a depression diagnosis (PHPT 34.1%, thyroid surgery, 35.5%, P = 0.86). However, baseline PHQ‐9 scores were significantly higher in PHPT (median 7.5, range 0‐27) than thyroid surgery patients (median 3.0, range 0‐18, P < 0.0001). Following surgery, all PHQ‐9 scores, total and symptom group (cognitive, somatic) improved and were no longer different between PHPT (total PHQ‐9 median 2, range 0‐16) and thyroid (median 1, range 0‐14, P = 0.31) groups. Baseline parathyroid hormone level, but not calcium, had a weak relationship with change in PHQ‐9 score after parathyroid surgery (P = 0.003). Baseline PHQ‐9 score was correlated with change in PHQ‐9 score at 12 months after parathyroid surgery (P < 0.001). Conclusions Depression scores improve in both somatic and cognitive domains after parathyroidectomy for PHPT and baseline severity of depression predicts the response.

Alice in Wonderland syndrome and bipolar depression

“…4 Parathyroidectomy in patients with HPT has shown to improve depression scores regardless of the biochemical severity of HPT. 5 In our case, we see an initial improvement in depressive symptoms after starting ECT, and further improvement after parathyroidectomy and continuing ECT. Regardless of the possible effect of parathyroidectomy on Mrs D's mood, ECT seems to have been effective in reducing depressive symptoms.…”

“…Neurocognitive symptoms are common in HPT and include anxiety, poor concentration, and cognitive decline 4 . Parathyroidectomy in patients with HPT has shown to improve depression scores regardless of the biochemical severity of HPT 5 . In our case, we see an initial improvement in depressive symptoms after starting ECT, and further improvement after parathyroidectomy and continuing ECT.…”

Parathyroid Hormone (PTH)-Related Peptides Family: An Intriguing Role in the Central Nervous System

“…On the other hand, the inappropriate increase in PTH in patients affected by Primary Hyperparathyroidism (PHPT) [82,83] is correlated with a variety of neuropsychological symptoms, ranging from depression, anxiety, and sleeping disorders to dementia, psychosis, and cognitive decline [84]. Most neuropsychological symptoms are described in symptomatic PHPT, which is generally related to severe hypercalcemia, but they are also present in asymptomatic PHPT, with a prevalence of up to 60% of patients in some settings [85,86]. Prospective case-control studies have shown cognitive impairment, reduction in verbal and non-verbal memory, and a deficit of attention and semantic fluency, as evaluated by specific neuropsychological tests [87,88].…”

Classical and Nonclassical Manifestations of Primary Hyperparathyroidism

“…(146) Most of them are described only in severe PHPT; their prevalence ranges from 3% to 50%. (7,19,(136)(137)(138)(151)(152)(153) In patients not complaining of these features, specific questionnaires have yielded a high prevalence (18%-61%) of neuropsychiatric issues and cognitive impairment in some studies. (140,152,(153)(154)(155)(156)(157)(158)(159)(160) Depression, anxiety, suicidal ideation, impaired memory, and disturbances in attention and executive function were most frequently reported.…”