Persistent symptomatic improvement at more than 12 months after parathyroidectomy for primary hyperparathyrodism
Preethi Gopinath, Gregory Sadler & Radu Mihai
Background: Parathyroidectomy for primary hyperparathyroidism (PHPT) is followed by a decrease in the severity of symptoms reported on the Pasiekas parathyroid symptoms score (PPSS) questionnaires and such changes correlate with improved quality of life assessed by the SF36 questionnaire (World J Surg 2008 32 807). Some argue that these benefits are short-lived and only apparent in the first months postoperatively.
Aim: To determine whether there is a persistent improvement in symptoms at more than 12 months after parathyroidectomy.
Methods: A prospective database collected clinical and operative information on consecutive patients with biochemical diagnosis of PHPT. PPSS was calculated as the sum of the 13 parameters self-assessed using a visual analogue scale (max 1300). SF-36(v2) analysis was made using commercially available software (QualityMetric Inc., Lincoln, USA). Data were compared using paired t-test.
Results: Between Nov 2006 and April 2009 190 patients (133F:57M, age 1589 years, median 62 years) diagnosed with PHPT (Ca 2.90±0.25 mmol/l, PTH 10.5±4.6 pmol/l) had scan-directed minimally invasive parathyroidectomy (n=131) or bilateral neck exploration (n=54). Preoperative PPSS scores ranged 01260 (median 415) and did not correlate with the severity of hypercalcaemia.
All patients were contacted at 16±6 months (median 15 months) postoperatively. There were 106 replies. The 1-year PPSS (237±208) were significantly lower than preoperative scores (417±240, P<0.0001). The improvement in symptoms was most significant for mood (35±33 vs 16±23) and tiredness (56±29 vs 31±27) (P<0.0001). Some two thirds of patients experienced persistent symptomatic benefits (Table).
Conclusion: Symptomatic benefits after parathyroidectomy for PHPT persist for at least 1 year in at least two thirds of patients. The Pasiekas questionnaire could be used to monitor symptoms and compare outcome in patients operated or observed during long-term follow-up for PHPT.