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

Abstract

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.

Clinical characteristics and depression score response after parathyroidectomy in primary hyperparathyroidism

“…Interestingly, after surgery, the mild group had 9 of 10 domains on parity with the general population but the classic group had only 6, which once again suggests that PHPT disease severity may not predict symptom improvement with surgery and even those with ‘mild’ disease may experience symptom improvement. Blanchard et al reported that among asymptomatic patients with PHPT, which included some with normal calcium, nonspecific symptoms improved following parathyroidectomy . However, subgroup analyses showed greater symptom improvement, including depression, in those individuals with calcium above normal preoperatively.…”

Effect of parathyroidectomy on quality of life and non-specific symptoms in normocalcaemic primary hyperparathyroidism

“…Twenty‐five non‐specific physical and neurocognitive symptoms described previously in association with mild PHPT were assessed using a self‐administered questionnaire.…”

“…In two previous studies, Blanchard and colleagues evaluated non‐specific symptoms and their impact on QoL in patients with Hc‐m‐PHPT who were later treated by parathyroidectomy; they concluded that surgery does improve QoL and non‐specific symptoms in this group, with better results among younger patients. These findings form the basis of the present study of whether the same non‐specific symptoms are observed in NcPHPT, how these affect QoL, and whether parathyroidectomy could help alleviate some of these symptoms or improve the QoL of patients with normocalcaemia.…”

Italian Society of Endocrinology Consensus Statement: definition, evaluation and management of patients with mild primary hyperparathyroidism

“…Younger patients and those with higher preoperative calcium levels showed the best improvement [59].…”

“…Younger patients and those with higher preoperative calcium levels (>10.4 mg/dL) show the best improvement [59]. However, it is important to consider that PTX, particularly if performed by unexperienced neck surgeons, may be complicated by side effects, which could be invalidating and not acceptable in a subject with a mild disease associated with a good quality of life.…”