Background: The optimum management strategy for primary hyperparathyroidism remains debatable especially in patients with mild or asymptomatic disease. We aimed to compare the baseline characteristics and long-term outcomes of patients with primary hyperparathyroidism who were either managed conservatively or underwent elective parathyroidectomy.
Methodology: We carried out a retrospective cohort analysis of patients with primary hyperparathyroidism under follow-up at the Royal Glamorgan Hospital, Wales from 1995 to 2016. The baseline characteristics were recorded from case records while the clinical portal was used to collate biochemical and radiological data. The patients were categorised into two main groups based on management approach (conservative treatment vs elective parathyroidectomy group).
Results: Out of a total of 336 patients with confirmed primary hyperparathyroidism, 72 (21.4%) underwent elective parathyroidectomy. Mean duration of follow up was shorter for the surgically treated patients as compared to the ones treated conservatively (3.7 vs 5.2 years). There was no significant difference between mean calcium levels at diagnosis although the mean parathyroid hormone (PTH) level at diagnosis was significantly higher in the surgical group (15.0 vs 11.4, P=0.038). Despite age adjustment using binary logistic regression, prevalence of hypertension and ischaemic heart disease was significantly lower in patients undergoing elective parathyroidectomy as compared to the group managed conservatively.
Conclusion: There was a significant difference in prevalence of hypertension and ischaemic heart disease in patients managed conservatively as compared to the group who underwent elective parathyroidectomy despite adjustment for age. The duration of follow up for this group was relatively shorter which can potentially off-set costs associated with surgery. The higher PTH levels at baseline for the elective parathyroidectomy group may also signify a correlation of PTH levels with increased risk of complications. Prospective large randomised controlled trials need to be designed to assess cardiovascular outcomes comparing surgical versus conservative management approach.
20 May 2017 - 23 May 2017