Skip to main content

Persistent symptomatic improvement in the majority of patients undergoing parathyroidectomy for primary hyperparathyroidism

Langenbeck's Archives of Surgery volume 395, pages 941–946 (2010)Cite this article

Abstract

Background

Parathyroidectomy for primary hyperparathyroidism (PHPT) is followed by a decrease in the severity of symptoms reported on the Pasieka’s parathyroid symptoms score (PPSS) and SF-36 questionnaires. Some argue that such benefits are short-lived. This study investigates the severity of symptoms at more than 12 months after parathyroidectomy.

Methods

A prospective database collected clinical/operative data on consecutive patients with PHPT. PPSS was calculated as the sum of the 13 parameters self-assessed using a visual analog scale. SF-36(v2) was analyzed using commercially available software (QualityMetric Inc., Lincoln, USA).

Results

Over 3-year interval, 166 patients (119 F/47 M, age 15–89 years) were operated for with PHPT (Ca 2.90 ± 0.25 mmol/L, PTH 21.64 ± 23.05 pmol/L). Their preoperative PPSS ranged 0–1,260 (median 413) and did not correlate with the severity of hypercalcemia. One hundred and seven patients responded when contacted by post at 18 ± 6 months postoperatively. Their postoperative PPSS was significantly lower (398 ± 226 to 231 ± 203, p < 0.001) and in 55 of 107 patients the severity of symptoms reduced by at least 50%. Most significant improvements were for mood (36 ± 33 vs. 16 ± 23), weakness/tiredness (37 ± 32 vs. 17 ± 23), irritability (35 ± 31 vs. 17 ± 21), and thirst (37 ± 32 vs. 18 ± 25; p < 0.0001). Physical and mental component scores of SF-36 questionnaire improved in patients whose PPSS decreased postoperatively.

Conclusion

Symptomatic benefits persist for at least 1 year after parathyroidectomy in the majority of patients with PHPT.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Bilezikian JP, Khan AA, Potts JT Jr (2009) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab 94:335–339

    CAS  Article  PubMed  Google Scholar 

  2. Caron NR, Pasieka JL (2009) What symptom improvement can be expected after operation for primary hyperparathyroidism? World J Surg 33:2244–2255

    Article  PubMed  Google Scholar 

  3. Mihai R, Wass JA, Sadler GP (2008) Asymptomatic hyperparathyroidism—need for multicentre studies. Clin Endocrinol (Oxf) 68:155–164

    CAS  Google Scholar 

  4. Zanocco K, Sturgeon C (2008) How should age at diagnosis impact treatment strategy in asymptomatic primary hyperparathyroidism? A cost-effectiveness analysis. Surgery 144:290–298

    Article  PubMed  Google Scholar 

  5. Eigelberger MS, Cheah WK, Ituarte PH, Streja L, Duh QY, Clark OH (2004) The NIH criteria for parathyroidectomy in asymptomatic primary hyperparathyroidism: are they too limited? Ann Surg 239:528–535

    Article  PubMed  Google Scholar 

  6. Sywak MS, Knowlton ST, Pasieka JL, Parsons LL, Jones J (2002) Do the National Institutes of Health consensus guidelines for parathyroidectomy predict symptom severity and surgical outcome in patients with primary hyperparathyroidism? Surgery 132:1013–1019, discussion 1019-1020

    Article  PubMed  Google Scholar 

  7. Talpos GB, Bone HG 3rd, Kleerekoper M, Phillips ER, Alam M, Honasoge M, Divine GW, Rao DS (2000) Randomized trial of parathyroidectomy in mild asymptomatic primary hyperparathyroidism: patient description and effects on the SF-36 health survey. Surgery 128:1013–1020, discussion 1020-1011

    CAS  Article  PubMed  Google Scholar 

  8. Caillard C, Sebag F, Mathonnet M, Gibelin H, Brunaud L, Loudot C, Kraimps JL, Hamy A, Bresler L, Charbonnel B, Leborgne J, Henry JF, Nguyen JM, Mirallie E (2007) Prospective evaluation of quality of life (SF-36v2) and nonspecific symptoms before and after cure of primary hyperparathyroidism (1-year follow-up). Surgery 141:153–159, discussion 159-160

    Article  PubMed  Google Scholar 

  9. Ambrogini E, Cetani F, Cianferotti L, Vignali E, Banti C, Viccica G, Oppo A, Miccoli P, Berti P, Bilezikian JP, Pinchera A, Marcocci C (2007) Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial. J Clin Endocrinol Metab 92:3114–3121

    CAS  Article  PubMed  Google Scholar 

  10. Rao DS, Phillips ER, Divine GW, Talpos GB (2004) Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab 89:5415–5422

    CAS  Article  PubMed  Google Scholar 

  11. Sheldon DG, Lee FT, Neil NJ, Ryan JA Jr (2002) Surgical treatment of hyperparathyroidism improves health-related quality of life. Arch Surg 137:1022–1026, discussion 1026-1028

    Article  PubMed  Google Scholar 

  12. Bollerslev J, Jansson S, Mollerup CL, Nordenstrom J, Lundgren E, Torring O, Varhaug JE, Baranowski M, Aanderud S, Franco C, Freyschuss B, Isaksen GA, Ueland T, Rosen T (2007) Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial. J Clin Endocrinol Metab 92:1687–1692

    CAS  Article  PubMed  Google Scholar 

  13. Coker LH, Rorie K, Cantley L, Kirkland K, Stump D, Burbank N, Tembreull T, Williamson J, Perrier N (2005) Primary hyperparathyroidism, cognition, and health-related quality of life. Ann Surg 242:642–650

    Article  PubMed  Google Scholar 

  14. Pasieka JL, Parsons LL (1998) Prospective surgical outcome study of relief of symptoms following surgery in patients with primary hyperparathyroidism. World J Surg 22:513–518, discussion 518-519

    CAS  Article  PubMed  Google Scholar 

  15. Pasieka JL, Parsons LL, Demeure MJ, Wilson S, Malycha P, Jones J, Krzywda B (2002) Patient-based surgical outcome tool demonstrating alleviation of symptoms following parathyroidectomy in patients with primary hyperparathyroidism. World J Surg 26:942–949

    Article  PubMed  Google Scholar 

  16. Greutelaers B, Kullen K, Kollias J, Bochner M, Roberts A, Wittert G, Pasieka J, Malycha P (2004) Pasieka Illness Questionnaire: its value in primary hyperparathyroidism. ANZ J Surg 74:112–115

    Article  PubMed  Google Scholar 

  17. Mihai R, Sadler GP (2008) Pasieka's parathyroid symptoms scores correlate with SF-36 scores in patients undergoing surgery for primary hyperparathyroidism. World J Surg 32:807–814

    Article  PubMed  Google Scholar 

  18. Mihai R, Palazzo FF, Gleeson FV, Sadler GP (2007) Minimally invasive parathyroidectomy without intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism. Br J Surg 94:42–47

    CAS  Article  PubMed  Google Scholar 

  19. Stechman MJ, Weisters M, Gleeson FV, Sadler GP, Mihai R (2009) Parathyroidectomy is safe and improves symptoms in elderly patients with primary hyperparathyroidism (PHPT). Clin Endocrinol (Oxf) 71:787–791

    Article  Google Scholar 

  20. Egan KR, Adler JT, Olson JE, Chen H (2007) Parathyroidectomy for primary hyperparathyroidism in octogenarians and nonagenarians: a risk-benefit analysis. J Surg Res 140:194–198

    Article  PubMed  Google Scholar 

  21. Chiba Y, Satoh K, Ueda S, Kanazawa N, Tamura Y, Horiuchi T (2007) Marked improvement of psychiatric symptoms after parathyroidectomy in elderly primary hyperparathyroidism. Endocr J 54:379–383

    Article  PubMed  Google Scholar 

  22. Hamdy NA (2009) Parathyroid gland: is parathyroidectomy safe and beneficial in the elderly? Nat Rev Endocrinol 5:422–423

    Article  PubMed  Google Scholar 

  23. Weber T, Keller M, Hense I, Pietsch A, Hinz U, Schilling T, Nawroth P, Klar E, Buchler MW (2007) Effect of parathyroidectomy on quality of life and neuropsychological symptoms in primary hyperparathyroidism. World J Surg 31:1202–1209

    Article  PubMed  Google Scholar 

  24. Quiros RM, Alef MJ, Wilhelm SM, Djuricin G, Loviscek K, Prinz RA (2003) Health-related quality of life in hyperparathyroidism measurably improves after parathyroidectomy. Surgery 134:675–681, discussion 681-673

    CAS  Article  PubMed  Google Scholar 

  25. Pasieka JL, Parsons L, Jones J (2009) The long-term benefit of parathyroidectomy in primary hyperparathyroidism: a 10-year prospective surgical outcome study. Surgery 146:1006–1013

    Article  PubMed  Google Scholar 

  26. Tang T, Dolan S, Robinson B, Delbridge L (2007) Does the surgical approach affect quality of life outcomes? A comparison of minimally invasive parathyroidectomy with open parathyroidectomy. Int J Surg 5:17–22

    Article  PubMed  Google Scholar 

  27. Pasieka JL, Parsons LL (2000) A prospective surgical outcome study assessing the impact of parathyroidectomy on symptoms in patients with secondary and tertiary hyperparathyroidism. Surgery 128:531–539

    CAS  Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Financial suppport

None

Author information

Authors and Affiliations

  1. Department of Endocrine Surgery, John Radcliffe Hospital, Oxford, OX3 9DU, UK

    Preethi Gopinath, Gregory P. Sadler & Radu Mihai

Authors
  1. Preethi Gopinath
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregory P. Sadler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Radu Mihai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Radu Mihai.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Gopinath, P., Sadler, G.P. & Mihai, R. Persistent symptomatic improvement in the majority of patients undergoing parathyroidectomy for primary hyperparathyroidism. Langenbecks Arch Surg 395, 941–946 (2010). https://doi.org/10.1007/s00423-010-0689-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-010-0689-z

Keywords

  • Primary hyperparathyroidism
  • Parathyroidectomy
  • Symptoms score
  • SF-36