Parathyroidectomy, Elevated Depression Scores, and Suicidal Ideation in Patients With Primary Hyperparathyroidism

Objective: Serum calcium (Ca 2C ) and parathyroid hormone (PTH), amongst others, modify cortical excitability. Alterations in cortical excitability were shown in patients with epilepsy as well as hyper-or hypoparathyroidism. In patients with primary hyperparathyroidism (pHPT), preoperative elevated serum calcium and parathyroidectomy (PTx) may affect mood and quality of life. We hypothesized that perioperative changes in Ca 2C and PTH in pHPT will affect cortical excitability and improve subjective health. Design and methods: Transcranial magnetic stimulation (TMS) was performed before and after surgery in 15 pHPT patients. We measured resting motor threshold, cortical silent period (CSP), short intracortical inhibition, and intracortical facilitation. Health questionnaires were administered before, 1 day and 6 months after PTx, along with the disease-specific Pasieka's parathyroid assessment of symptoms (PAS), which was, to our knowledge, its first use in German.Results: Surgery was successful in all patients. TMS-measurements remained unchanged when analyzing all patients in this pilot study. Postoperatively, depression declined (PZ0.05) and quality of life improved significantly (PZ0.001) in the SF-36-subscales: vitality, social functioning, mental health and subjective health transition (post-hoc analysis). The PAS proved early relief of disease-specific symptoms (P!0.001). Conclusions: We found unchanged cortical excitability comparing pre-and post-PTx in this pilot study. Mood and quality of life improved postoperatively. The German PAS is valuable in detecting disease-specific changes early after PTx.

Section: Discussionsupporting

confidence: 59%

Perioperative changes in cortical excitability, mood, and quality of life in patients with primary hyperparathyroidism: a pilot study using transcranial magnetic stimulation

Hermsen

Eienbröker

Haag

et al. 2014

“…Roman et al (17) showed that reduction in mood swings and anxiety symptoms were associated with reduction of PTH level in patients with pHPT who underwent successful parathyroidectomy. Weber et al (18) confirmed that depression, anxiety, and impaired quality of life were related to pHPT. In their Similarly to prior studies, this study has shown that patients with mild pHPT had nonspecific symptoms that remained significantly improved 1 year after surgery.…”

Section: Discussionmentioning

confidence: 95%

“…There was a significant improvement in symptoms between the preoperative and immediate postoperative period (between 7 and 10 days postoperatively). This study prospectively validated a score called Parathyroidectomy Assessment of Symptoms (PAS) score, specific to pHPT (18). This score was a scale to evaluate patients pre-and postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Surgery for ‘asymptomatic’ mild primary hyperparathyroidism improves some clinical symptoms postoperatively

Blanchard

Mathonnet

Sébag

et al. 2013

Objective and background: Most primary hyperparathyroidism (pHPT) patients do not conform to the guidelines for parathyroidectomy established by an international panel of specialists and have a mild pHPT. This group is typically defined as 'asymptomatic'. The primary aim of this study was to determine symptom improvement in this 'asymptomatic' group after parathyroidectomy. Secondly, we aimed to create a preoperative clinical score predicting postoperative symptom resolution. Design: A prospective nonrandomized study included patients with mild pHPT. Methods: A questionnaire (22 items) was given to 'asymptomatic' patients preoperatively and at 3, 6, and 12 postoperative months. A logistic regression was performed to create a preoperative clinical score. Results: One hundred and sixteen patients were included. Postoperatively, HPT was resolved in 98% of patients. Twelve of 22 nonspecific symptoms were improved at 1 year. Subgroups analysis showed a greater improvement in patients !70 years and those with a serum calcium level R2.6 mmol/l preoperatively. A clinical score, based on age and five symptoms, was established to predict the clinical improvement after surgery in mild pHPT patients with a positive predictive value of 81%. Conclusion: Patients with asymptomatic pHPT have clinical improvement of their symptoms postoperatively even after 1 year. Younger patients and those with higher preoperative calcium levels show the best improvement.

“…It is well known that PHPT is associated with a reduced QoL as measured by SF-36 (27), and may exert negative effects on neuronal function and synaptic plasticity (28). Moreover, receptors for PTH are expressed in central nervous tissues (7) and high PTH levels may adversely affect psychological and cognitive functions (6), as well as elevated PTH and Ca 2C levels may cause cerebral hypoperfusion (29).…”

Section: Discussionmentioning

confidence: 99%

No beneficial effects of vitamin D supplementation on muscle function or quality of life in primary hyperparathyroidism: results from a randomized controlled trial

Rolighed

Rejnmark

Sikjær

et al. 2015

Context: Impairments of muscle function and strength in patients with primary hyperparathyroidism (PHPT) are rarely addressed, although decreased muscle function may contribute to increased fracture risk. Objective: We aimed to assess the changes in muscle strength, muscle function, postural stability, quality of life (QoL), and well-being during treatment with vitamin D or placebo before and after parathyroidectomy (PTX) in PHPT patients. Design: A randomized placebo-controlled trial. Patients: We included 46 PHPT patients, mean age 58 (range 29-77) years and 35 (76%) were women. Interventions: Daily treatment with 70 mg (2800 IU) cholecalciferol or placebo for 52 weeks. Treatment was administered 26 weeks before PTX and continued for 26 weeks after PTX. Main outcome measures: Changes in QoL and measures of muscle strength and function. Results: Preoperatively, 25-hydroxyvitamin D (25OHD) increased significantly (50-94 nmol/l) compared with placebo (57-52 nmol/l). We did not measure any beneficial effects of supplementation with vitamin D compared with placebo regarding well-being, QoL, postural stability, muscle strength, or function. In all patients, we measured marked improvements in QoL, well-being (P!0.01), muscle strength in the knee flexion and extension (P!0.001), and muscle function tests (P!0.01) after surgical cure. Postural stability improved during standing with eyes closed (P!0.05), but decreased with eyes open (P!0.05). Conclusions: Patients with PHPT and 25OHD levels around 50 nmol/l did not benefit from vitamin D supplementation concerning muscle strength, muscle function, postural stability, well-being, or QoL. Independent of preoperative 25OHD levels, PTX improved these parameters.