Surgery Significantly Improves Neurocognition, Sleep, and Blood Pressure in Primary Hyperparathyroidism: A 3-Year Prospective Follow-Up Study

Abstract

Surgery for primary hyperparathyroidism (PHPT) improves health-related quality of life (HRQoL), but it is unclear whether the effects are sustained after medium-term (>2 years) follow-up, and whether the results on some or all dimensions of HRQoL will reach that of the general population. We performed a follow-up of HRQoL on average 3.3 years after surgery for PHPT using the 15D in our patient cohort (n=124) and compared the results to those of an age- and gender-standardized general population (n=1099). We studied self-reported blood pressure and current medications; new comorbidities were retrieved from electronic patient records. A total of 104 (83%) patients [eight with serum calcium (1.34-1.46 mmol/l)] returned the questionnaires. After a follow-up of 3.3 years (range 23 to 55 months), systolic and diastolic blood pressure had decreased significantly compared to baseline (the situation before surgery, p<0.001). Thirty-four (33%) had acquired a new diagnosis (range 1-7), the most common being cardiovascular disease and cancer. Mean 15D score was significantly better compared to baseline (p<0.001), the dimensions of sleeping, mental function, discomfort and symptoms, and depression had further improved (p<0.01), and no longer differed from that of the general population. In PHPT, after >2 years follow-up, surgery improves blood pressure and restores neurocognitive function and sleep to the level of the general population. The improvements observed in overall HRQoL at one year after surgery are sustained, but overall HRQoL does not reach that of the general population.

Clinical characteristics and depression score response after parathyroidectomy in primary hyperparathyroidism

“…We chose to analyse the 12‐month data for this report because the maximum change from respective baselines occurred in both groups at this time point. Improvements in neurocognitive function after parathyroidectomy have been reported as early as 1 week in a small uncontrolled cohort study, and sustained improvements >2 years after parathyroidectomy have also been reported . The ability of a recent meta‐analysis to estimate the potential benefits of surgery versus active surveillance in mild hyperparathyroidism, including mental health benefits, was limited due to the paucity of good quality studies .…”

“…Improvements in neurocognitive function after parathyroidectomy have been reported as early as 1 week in a small uncontrolled cohort study, 25 and sustained improvements >2 years after parathyroidectomy have also been reported. 8 The ability of a recent meta-analysis to estimate the potential benefits of surgery versus active surveillance in mild hyperparathyroidism, including mental health benefits, was limited due to the paucity of good quality studies. 26 With this limitation, the authors concluded that no significant differences in neuropsychiatric symptoms were observed between surgery and active surveillance.…”

“…A number of observational studies have examined the response of neuropsychiatric symptoms to surgical cure of PHPT using a variety of assessment tools. Improvement in neuropsychiatric symptoms after surgery has been reported in some studies but not in others . Most lacked a control group of untreated or observed individuals with PHPT.…”

Health‐related quality of life improves 1 year after parathyroidectomy in primary hyperparathyroidism: A prospective cohort study

“…Numerous observational studies have evaluated the effect of PTX in PHPT using the SF‐36 survey as well as other non‐disease‐specific questionnaires, suggesting improvement in HRQoL . An observational study by Rolighed et al HRQoL, assessed by SF‐36, were reduced in all 8 domains compared to healthy controls.…”

Unmet therapeutic, educational and scientific needs in parathyroid disorders: Consensus Statement from the first European Society of Endocrinology Workshop (PARAT)

“…Patients with mild or asymptomatic PHPT have decreased QoL based on generic QoL questionnaires (2, 127, 128, 129, 130). Numerous observational studies including the most recent have indicated a positive treatment effect of surgery on QoL (131, 132, 133). Randomized controlled studies have shown ambiguous results (128, 129, 130), demonstrating no significant effect of surgical treatment on QoL in patients not fulfilling the surgical criteria for PHPT, as summarized in a recent meta-analysis (134).…”