Quality of life in patients with primary hyperparathyroidism before and after parathyroidectomy: long term single center experience

Abstract

Background Primary hyperparathyroidism (PHPT) is a common endocrine disorder caused by a parathyroid tumor or hyperplasia, which is often accompanied with quality of life (QoL) impairment. A parathyroidectomy (PTX) is the preferred standard treatment for PHPT patients. In this single center study we aimed to evaluate the impact of PHPT on patient’s QoL and identify QoL changes at early and long-term follow-up after surgery. Methods All the patients underwent routine PTX with the removal of the suspected hyperparathyroid gland(s). Patients filled out generic QoL questionnaire RAND SF-36, specific questionnaire PHPQoL and specific symptom assessment questionnaire PAS upon admission to the hospital before surgery, at 3 months, 12 months and 24 months after surgery. Results A total of 92 patients with PHPT (median age was 56 years, 95.7% females) were included in the study. Before PTX patient’s QoL by SF-36 scores was significantly lower as compared to healthy controls (p < 0.01). Almost 40% of patients had poor or very poor QoL. The most frequent symptoms by PAS before surgery were as follows: tiredness (97.8% of patients), weakness (94.6%), forgetfulness (94.6%), mood changes (90%), feeling “blue”/depression (88%), joint pains (83.3%), headaches (80.2%), constant irritability (77.2%), bone pains (75%), thirst (70.7%) and trouble getting out of a chair (67.4%). The half of the patients had moderate-to-severe (≥ 40 scores) tiredness, weakness, joint pains, forgetfulness, as well as mood changes. Post-operative QoL changes were analysed in the group of 72 patients. After surgery there was significant improvement in QoL by all scales of SF-36 questionnaire, excluding bodily pain, and the PHPQoL total score (GEE, p < 0.01) as compared with their values before surgery. Also severity of tiredness, mood changes, weakness and forgetfulness significantly decreased after surgery as compared to their baseline values (GEE, p < 0.05). Decreased mental component of QoL by PHPQoL (OR = 0.927, 95%CI = 0.874–0.984, p = 0.013) predicted improved QoL after surgery. Conclusions Patients with PHPT demonstrated significantly impaired QoL in physical, psychological and social functioning as well experienced a wide profile of common PHPT symptoms. Successful PTX was accompanied with remarkable QoL improvement and decrease in subjective symptoms for at least 24 months after surgery.

Involuntary Falls in Patients with Chronic Kidney Diseases on Nephrology Wards: Research Advances and Future Perspectives

“…Parathyroid excision can significantly improve negative physical and psychological symptoms and enhance the quality of life. 59 Despite the high effectiveness of this procedure in treating the aforementioned conditions, it is essential to acknowledge the existence of potential risks and hazards. One notable risk is the development of hypocalcemia following parathyroidectomy, 60 which can manifest as muscle spasms, neurological complications, cardiac arrhythmias, and in severe instances, life-threatening situations.…”

Neuroendocrine Parathyroid Tumors: Quality of Life in Patients with Primary Hyperparathyroidism

“…Some clinical elements such as muscle weakness or joints/bones non-specific pain may be evident, while others such as depression or feeling "blue" might be underestimated by a usual endocrine check-up, although other hormone anomaly-associated conditions might be associated with a similar presentation (for example, severe hypothyroidism or Cushing's syndrome) [67,68]. Concerning PHP, we mention the study from 2023 of Ionova et al [69] that showed that 88% of the 92 individuals with PHP (median age of 56 years, mostly females) had such complaints. The authors also revealed that SF-36-based QoL was statistically significantly lower than the general (non-PHP) population (p < 0.001), while one out of ten subjects fit into the category of a very poor QoL score.…”

“…A total of 1327 subjects diagnosed with PHP had a QoL evaluation. The studies with the largest number of individuals were of 92 [69], 104 [24], 110 [46], 134 [19], 159 [74], as well as SIPH (which enrolled 95 persons as PTx groups and 96 subjects as non-PTx groups). A few cohorts (n = 5) were of small size (between 20 and 40 patients in each of them) [14,17,25,27,36].…”

“…Our five-year analysis based on sample-study data identified 16 original studies according to our methods: three published in 2023, four-2022, four-2021, one-2020, three-2019, and one in 2018 [12][13][14]17,19,20,[24][25][26][27]36,46,64,69,73,74] (Table 1). Table 1.…”

“…Original studies on QoL scores in patients with parathyroid tumors (primary hyperparathyroidism), published between January 2018 and May 2023 (the studies are displayed based on the year of publication, starting with the most recent) [12][13][14]17,19,20,[24][25][26][27]36,46,64,69,73,74]. Apart from one decade-based study [13], Ionova et al according to their prospective study published in 2023 used a 2-year time frame since surgery [69]. Frey et al also used a prospective design and repeated QoL analysis after 1 year, respectively, 3 years since parathyroid removal [74], as did Tzikos et al [25].…”