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Febrero B, Ruiz-Manzanera JJ, Ros-Madrid I, Hernández-Martínez AM, Rodríguez JM. The Influence of Hyperparathyroidism Patient Profile on Quality of Life After Parathyroidectomy. World J Surg 2023; 47:2197-2205. [PMID: 37210692 DOI: 10.1007/s00268-023-07066-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Improvements in quality of life (QoL) after parathyroidectomy in patients with primary hyperparathyroidism (PHPT) is discussed. It has not been analyzed whether these improvements can be influenced by a specific socio-personal or clinical patient profile. OBJECTIVES to analyze QoL differences after parathyroidectomy and to determine a socio-personal and clinical profile that influences improvement after parathyroidectomy. METHODS A longitudinal prospective cohort study in patients with PHPT. SF-36 and PHPQOL questionnaires were completed by the patients. A comparative preoperatory analysis was carried out, at three and twelve months after surgery. Student's t test was used for the correlations. The size of the effect was assessed using G*Power software. A multivariate analysis was performed to evaluate the socio-personal and clinical variables affecting the improvement in QoL after surgery. RESULTS Forty-eight patients were analyzed. Three months after surgery an improvement was found in physical function, general health, vitality, social function, emotional role, mental health and in the patient's declared health assessment. One year after the intervention a general improvement was observed, with a greater effect on mental health and declared health evolution. Patients with bone pain presented with a higher probability of improvement after surgery. Patients with prior psychological disease had a lower associated probability of an improvement and high levels of PTH related to a greater probability of improvement after surgery. CONCLUSIONS There is an improvement in the QoL of PHPT patients after parathyroidectomy. Patients with bone pain and high PTH levels prior to the parathyroidectomy present with a greater probability of having a greater improvement in QoL after surgery.
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Affiliation(s)
- Beatriz Febrero
- Department of Endocrine Surgery, General Surgery Service, Virgen de La Arrixaca University Hospital, Murcia, Spain
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
| | - Juan José Ruiz-Manzanera
- Department of Endocrine Surgery, General Surgery Service, Virgen de La Arrixaca University Hospital, Murcia, Spain.
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.
| | - Inmaculada Ros-Madrid
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
- Department of Endocrinology and Nutrition, Virgen de La Arrixaca University Hospital, Murcia, Spain
| | - Antonio-Miguel Hernández-Martínez
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
- Department of Endocrinology and Nutrition, Virgen de La Arrixaca University Hospital, Murcia, Spain
| | - José M Rodríguez
- Department of Endocrine Surgery, General Surgery Service, Virgen de La Arrixaca University Hospital, Murcia, Spain
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
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Quality of life, mood and sleep quality in patients with primary hyperparathyroidism. Impact of socio-personal and clinical profile. ANNALES D'ENDOCRINOLOGIE 2023; 84:1-7. [PMID: 36202230 DOI: 10.1016/j.ando.2022.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/22/2022] [Accepted: 08/23/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Quality of life (QoL) in patients with primary hyperparathyroidism (PHPT) can be negatively affected by the disease, and it is important to identify risk factors. The objectives of the present study were to analyze QoL, mood and quality of sleep in patients with PHPT and to determine the impact of socio-personal and clinical variables. PATIENTS AND METHOD The study group included patients diagnosed with PHPT, and the control group was taken from general population, paired by age and gender. QoL was analyzed using the SF-36 and the PHPQoL questionnaires. The Beck-II and Pittsburg questionnaires were used to assess depression and sleep quality. Socio-personal and clinical variables were analyzed. Statistical analysis on SPSS software v.28 used the Student t-test, ANOVA, Pearson's rank correlation, Mann-Whitney test, Kruskal-Wallis test and Spearman's rank correlation. A multiple linear regression model of the QoL was constructed. RESULTS Sixty-five patients with PHPT were analyzed. A greater negative effect on QoL, mood and sleep quality were observed in patients with PHPT than in controls (P<0.05), with a good correlation between the various questionnaires. Several socio-personal variables had an effect on QoL and mood (P<0.05). QoL in patients with PHPT was affected by educational level, having offspring, and psychological symptoms (P<0.05). CONCLUSIONS Patients with PHPT had poorer QoL and greater neurocognitive disorder than the general population. Socio-personal profile should be taken into account in the clinical assessment of these patients, together with psychological symptoms.
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Livschitz J, Yen TWF, Evans DB, Wang TS, Dream S. Long-term Quality of Life After Parathyroidectomy for Primary Hyperparathyroidism: A Systematic Review. JAMA Surg 2022; 157:2796289. [PMID: 36103163 DOI: 10.1001/jamasurg.2022.4249] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Importance Definitive treatment of primary hyperparathyroidism (pHPT) with curative parathyroidectomy has been shown to improve nonspecific neurocognitive symptoms and may improve long-term quality of life (QOL). However, QOL is not currently routinely assessed preoperatively, and as a result, diminished QOL may be overlooked as an indication for surgery. Objective To examine results for measures of long-term QOL after parathyroidectomy in patients with pHPT. Evidence Review A systematic, English-language literature review was performed to assess the long-term association of parathyroidectomy, defined as a minimum of 1-year postoperative follow-up, with QOL in patients with pHPT. We conducted a search of PubMed and Scopus using Medical Subject Heading (MeSH) terms for hyperparathyroidism, parathyroid hormone, parathyroidectomy, hypercalcemia, and quality of life. All relevant literature published between June 1998 and February 15, 2021, was included. Study selection was guided by the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) strategy. Findings Thirty-one studies conducted in 14 countries with a minimum of 1 year of follow-up were included, comprising 3298 patients with pHPT (2975 underwent parathyroidectomy; 323 were observed), 5445 age- and sex-matched control participants, and 386 control patients with benign thyroid disease. To assess QOL, 21 studies (68%) used a general tool, the 36-item Short Form Survey (SF-36), and 8 (26%) used the disease-specific tool Parathyroidectomy Assessment of Symptoms (PAS). The remaining studies used a combination of 10 additional QOL tools. The median follow-up period was 1 year (range, 1-10 years). Of the 31 studies, 27 (87%) demonstrated significant score improvement in long-term QOL after parathyroidectomy, including 1 study that showed continued improvement in QOL 10 years after parathyroidectomy. The remaining 4 studies (13%) reported mixed results. Conclusions and Relevance This systematic review suggests that parathyroidectomy is associated with improved and sustained QOL in patients with pHPT. Patients with pHPT should be screened with a validated QOL tool such as the SF-36 or PAS at the time of diagnosis to guide discussion of these symptoms in the preoperative setting and the potential for long-term improvement after curative parathyroidectomy.
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Affiliation(s)
| | - Tina W F Yen
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Douglas B Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Sophie Dream
- Department of Surgery, Medical College of Wisconsin, Milwaukee
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Liu L, Zhang JQ, Wang GG, Zhao K, Guo C, Huang C, Li SQ, Chen YY. Surgical Treatment of Ectopic Mediastinal Parathyroid Tumors: A 23-Year Clinical Data Study in a Single Center. J INVEST SURG 2022; 35:1747-1753. [PMID: 35914896 DOI: 10.1080/08941939.2022.2106392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Background. Ectopic mediastinal parathyroid glands are parathyroid glands located completely below the clavicle. At present, most literature reports on ectopic mediastinal parathyroid tumors (EMPT) are case reports or small case sequences.Methods. This study conducted a retrospective analysis of ectopic mediastinal parathyroid tumors cases treated over the past 23 years, summarizing and analyzing general conditions, preoperative positioning, postoperative pathology, intraoperative conditions, and long-term follow-up results.Results. This study enrolled 28 patients. Among them, 27 patients underwent preoperative localization diagnosis using 99mTc-sestamibi scan (MIBI) in conjunction with chest computed tomography (CT), including 26 cases of the anterior superior mediastinum and 2 cases of middle mediastinum. Postoperative pathology revealed 23 cases of parathyroid adenoma, 4 cases of parathyroid hyperplasia, and 1 case of parathyroid cyst. In this study, 12 patients underwent video-assisted thoracoscopic surgery (VATS) and thoracotomy approaches. Using Mann-Whitney U test, we discovered that VATS approach group is significantly superior in surgical time (P = 0.039) and intraoperative bleeding (P < 0.001). Within one week of surgery, 26 patients with primary hyperparathyroidism (PHPT) experienced a significant decrease in blood parathyroid hormone (PTH) (P < 0.001) and blood calcium (P < 0.001), and all achieved long-term remission.Conclusions. EMPT is most frequently performed in the anterior superior mediastinum. EMPT is predominantly parathyroid tumors, and most of them are associated with PHPT. MIBI and chest CT combination can be used for preoperative lesion localization (positive rate 96.15%). VATS can be used as a better surgical approach. PHPT patients before surgery can achieve long-term symptom relief with surgical treatment.
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Affiliation(s)
- Lei Liu
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Jia-Qi Zhang
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Gui-Ge Wang
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Ke Zhao
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Chao Guo
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Shan-Qing Li
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
| | - Ye-Ye Chen
- Department of Thoracic Surgery, Peking, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking, P.R. China
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Papavramidis TS, Anagnostis P, Pliakos I, Tzikos G, Chorti A, Kotsa K, Michalopoulos A. The impact of age on quality of life and frailty outcomes after parathyroidectomy in patients with primary hyperparathyroidism. J Endocrinol Invest 2022; 45:797-802. [PMID: 34826129 DOI: 10.1007/s40618-021-01710-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Parathyroidectomy (PTx) improves quality of life (QoL) in patients with primary hyperparathyroidism (PHPT). Whether this effect is modified according to the patients' age is unknown. The aim of this study was to evaluate the impact of age on the effect of PTx on QoL and frailty in patients with PHPT, six months post-PTx. METHODS This was a prospective cohort study, including patients with PHPT, admitted from January 2016 to December 2019, divided into two categories: younger (≤ 65 years old) and older (> 65 years old). QoL was assessed with the Pasieka questionnaire (PAS-Q) two days pre- and six months post-operatively. Frailty was also assessed at the same time intervals, with the Frailty Index (FI). RESULTS One hundred and thirty-four patients (younger group: 96 patients, mean age 50.4 ± 9.8 years; older group: 38 patients, mean age 72.1 ± 4.9 years) were included. PTx resulted in a significant reduction in PAS-Q score in both groups. Notably, a greater reduction in "mood swings", "irritability", "itchy skin" and "feeling thirsty" PAS-Q domains was observed in the younger group. In contrast, a greater decrease in "bone pain", "tiredness", "weakness", "joint pain", "getting off chair" and "headaches" items was observed in the older group. Moreover, PTx led to a decrease in FI only in this group. CONCLUSIONS PTx leads to an improvement in QoL both in older (> 65 years) and younger (≤ 65 years) patients with PHPT, attributed to a differential effect on PAS-Q items. Frailty improves only in the older group.
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Affiliation(s)
- T S Papavramidis
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Minimal Invasive Endocrine Surgery, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - P Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - I Pliakos
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Minimal Invasive Endocrine Surgery, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - G Tzikos
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Chorti
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Kotsa
- Division of Endocrinology and Metabolism and Diabetes Center, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - A Michalopoulos
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Sutton W, Canner JK, Shank JB, Fingeret AL, Karzai S, Segev DL, Prescott JD, Mathur A. The impact of patient age on practice patterns and outcomes for primary hyperparathyroidism. Am J Surg 2022; 224:400-407. [DOI: 10.1016/j.amjsurg.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/04/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
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Parathyroidectomy for Mild Hyperparathyroidism in the Octogenarian: Is Age Really Just a Number? Ann Surg 2020; 272:e285-e286. [PMID: 33185998 DOI: 10.1097/sla.0000000000003940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Kota SK, Kota SK, Jammula S, Bhargav PRK, Sahoo AK, Das S, Talluri SC, Kongara S, S Krishna SV, Modi KD. Persistent Elevation of Parathormone Levels after Surgery for Primary Hyperparathyroidism. Indian J Endocrinol Metab 2020; 24:366-372. [PMID: 33088762 PMCID: PMC7540826 DOI: 10.4103/ijem.ijem_212_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/06/2020] [Accepted: 07/04/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Persistent elevation of serum parathyroid hormone (PTH) despite normocalcemia have been documented in 8- 40% of patients after parathyroidectomy. We hereby report our experience from different centers across India to determine clinical significance of postoperatively elevated PTH levels and review relevant literature. METHODS We conducted a retrospective case series study and reviewed all the patients who underwent surgery for primary hyperparathyroidism (PHPT) from April 2010 to January 2020. RESULTS Total of 201 patients was diagnosed as PHPT. Out of available follow-up data of 180 patients, a total of 54 patients (30%) had persistently elevated PTH (PePTH) at 1 month. Patients with PePTH were older with higher preoperative serum calcium, iPTH, alkaline phosphatase and lower serum phosphate and 25-hydroxy vitamin D3 levels. Creatinine clearance was found to be significantly lower in patients with PePTH. Multiple linear regression analysis revealed that preoperative 25-OH D3 concentration, creatinine clearance and iPTH are the factors influencing persistent elevation of PTH levels. Significantly lower serum calcium and higher alkaline phosphatase levels were observed in PePTH patients with preoperative 25-OH D3 levels <20 ng/mL. Thirty patients at 6 months, 24 patients at 1 year, 18 patients at 2 years and 9 patients at 3 years had eucalcemic PTH elevation. Nine out of 126 (7%) patients with normal initial postoperative calcium and iPTH levels developed PePTH, with none culminating into recurrent hyperparathyroidism. CONCLUSION Though the pathogenesis of such a phenomenon still remains to be elucidated, a multifactorial mechanism appears to play a role.
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Affiliation(s)
- Sunil K. Kota
- Endocrinology, DIABETES and ENDOCARE Clinic, Berhampur, Odisha, India
| | | | - Sruti Jammula
- Pharmaceutics, Roland Institute of Pharmaceutical Sciences, Berhampur, Odisha, India
| | - P R K Bhargav
- Endocrine Surgery, Endocare Hospital, Vijayawada, Andhra Pradesh, India
| | - Abhay K. Sahoo
- Endocrinology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sambit Das
- Endocrinology, Hi Tech Medical College, Bhubaneswar, Odisha, India
| | | | | | - S V S Krishna
- Endocrinology, Military Hospital, Secunderabad, Telangana, India
| | - K D Modi
- Endocrinology, CARE Hospital, Nampally, Hyderabad, Telangana, India
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Cipriani C, Bilezikian JP. Non-surgical management of primary hyperparathyroidism in the aging population. Maturitas 2020; 136:49-53. [PMID: 32386666 DOI: 10.1016/j.maturitas.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 01/24/2023]
Abstract
Primary hyperparathyroidism (PHPT) is commonly observed in the aging population, and the average age at diagnosis has increased in the last 20 years. Parathyroidectomy, the only definitive cure for PHPT, is indicated in symptomatic and asymptomatic older PHPT patients with skeletal and renal disease. It is as effective in older patients as it is in younger patients. Nevertheless, older patients may present with comorbidities and greater frailty, leading to the possibility of more complications, higher morbidity and mortality after surgery. This review focuses on the non-surgical clinical management of PHPT in elderly patients. We also summarize the most recent literature regarding the pharmacological management of PHPT to reduce serum calcium levels, to improve bone mineral density or to do both in the aging population.
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Affiliation(s)
- Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - John P Bilezikian
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA.
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10
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Khokar AM, Kuchta KM, Moo-Young TA, Winchester DJ, Prinz RA. Parathyroidectomy is Safe in Elderly Patients: A National Surgical Quality Improvement Program Study. World J Surg 2019; 44:526-536. [DOI: 10.1007/s00268-019-05280-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Alore EA, Suliburk JW, Ramsey DJ, Massarweh NN, Balentine CJ, Singh H, Awad SS, Makris KI. Diagnosis and Management of Primary Hyperparathyroidism Across the Veterans Affairs Health Care System. JAMA Intern Med 2019; 179:1220-1227. [PMID: 31305864 PMCID: PMC6632180 DOI: 10.1001/jamainternmed.2019.1747] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Untreated primary hyperparathyroidism impairs quality of life and incurs substantial costs. Parathyroidectomy is a low-risk, high-success, definitive intervention. OBJECTIVES To determine the appropriateness of diagnostic evaluation for primary hyperparathyroidism in patients with hypercalcemia and the use of parathyroidectomy for the treatment of primary hyperparathyroidism across the Veterans Affairs (VA) health care system. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of veterans with hypercalcemia and primary hyperparathyroidism was conducted from January 1, 2000, through September 30, 2015, using the VA Corporate Data Warehouse, a national electronic health record-based repository. The study included 371 370 veterans with chronic hypercalcemia and 47 158 veterans with biochemical evidence of primary hyperparathyroidism diagnosed by hypercalcemia, elevated serum parathyroid hormone levels, and near-normal serum creatinine levels. Statistical analysis was performed from April 21, 2017, to April 10, 2019. MAIN OUTCOMES AND MEASURES The proportion of veterans with hypercalcemia who have parathyroid hormone levels evaluated, the proportion of veterans with hyperparathyroidism who are treated surgically, and the factors associated with parathyroidectomy using generalized linear latent and mixed model regression. RESULTS Of 371 370 patients with chronic hypercalcemia, 86 887 (23.4%) received further testing with parathyroid hormone level. Of 47 158 patients meeting diagnostic criteria for primary hyperparathyroidism (42 737 men [90.6%] and 4421 women [9.4%]; mean [SD] age, 67.3 [11.8] years), 6048 (12.8%) underwent parathyroidectomy. Of 5793 patients with primary hyperparathyroidism presenting with a serum calcium level more than 1 mg/dL above the upper limit of normal, 1501 (25.9%) underwent parathyroidectomy. There was a decreasing trend in the use of parathyroidectomy over time. Factors positively associated with parathyroidectomy were nephrolithiasis (odds ratio [OR], 2.23; 95% CI, 1.90-2.61) and non-Hispanic white race/ethnicity (OR, 1.31; 95% CI, 1.17-1.46), while age (OR, 0.95; 95% CI, 0.95-0.96), Elixhauser Comorbidity Index score (OR, 0.76; 95% CI, 0.72-0.80), decreased estimated glomerular filtration rate (OR, 0.52; 95% CI, 0.45-0.60), and diagnosis of osteoporosis (OR, 0.65; 95% CI, 0.52-0.80) were inversely related to surgery. CONCLUSIONS AND RELEVANCE From this study's findings, parathyroid hormone level is infrequently tested in patients with hypercalcemia, suggesting underdiagnosis of primary hyperparathyroidism. Patients meeting diagnostic criteria for primary hyperparathyroidism are undertreated with recommended parathyroidectomy. Similar gaps have previously been observed in non-VA care of primary hyperparathyroidism, suggesting the need for a systematic evaluation of barriers to diagnosis and treatment that informs intervention design.
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Affiliation(s)
- Elizabeth A Alore
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - James W Suliburk
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, Texas
| | - David J Ramsey
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, Texas
| | - Nader N Massarweh
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, Texas.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Courtney J Balentine
- Department of Surgery, University of Texas Southwestern, Dallas.,Veterans Affairs North Texas Health Care System, Dallas
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, Texas.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Samir S Awad
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Konstantinos I Makris
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, Texas.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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12
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Isaacs KE, Belete S, Miller BJ, Di Marco AN, Kirby S, Barwick T, Tolley NS, Anderson JR, Palazzo FF. Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma. BJS Open 2019; 3:743-749. [PMID: 31832580 PMCID: PMC6887896 DOI: 10.1002/bjs5.50207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background Primary hyperparathyroidism (PHPT), caused by an ectopic mediastinal parathyroid adenoma, is uncommon. In the past, when the adenoma was not accessible from the neck, median sternotomy was advocated for safe and successful parathyroidectomy. Video‐assisted thoracoscopic surgical (VATS) parathyroidectomy represents a modern alternative approach to this problem. Methods Information on patients undergoing VATS was obtained from a specific database, including clinical presentation, biochemistry, preoperative imaging, surgical approach and patient outcomes. A comprehensive literature review was undertaken to draw comparisons with other publications. Results Over a 2‐year period, nine patients underwent VATS parathyroidectomy for sporadic PHPT. Five patients had persistent PHPT following previous unsuccessful parathyroidectomy via cervicotomy, and four had had no previous parathyroid surgery. The median duration of surgery was 90 (range 60–160) min. Eight patients were cured biochemically, with no major complications. One patient required conversion to a median sternotomy for removal of a thymoma that had resulted in false‐positive preoperative imaging. Conclusion With appropriate preoperative imaging, multidisciplinary input and expertise, VATS parathyroidectomy is an effective, safe and well tolerated approach to ectopic mediastinal parathyroid adenoma.
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Affiliation(s)
- K E Isaacs
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK
| | - S Belete
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK
| | - B J Miller
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK
| | - A N Di Marco
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK.,Department of Surgery & Cancer Imperial College London UK
| | - S Kirby
- Department of Radiology Imperial College Healthcare NHS Trust London UK
| | - T Barwick
- Department of Anaesthesia Imperial College Healthcare NHS Trust London UK
| | - N S Tolley
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK.,Department of Surgery & Cancer Imperial College London UK
| | - J R Anderson
- Department of Cardiothoracic Surgery, Hammersmith Hospital Imperial College Healthcare NHS Trust London UK
| | - F F Palazzo
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK.,Department of Surgery & Cancer Imperial College London UK
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13
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Seib CD, Chomsky-Higgins K, Gosnell JE, Shen WT, Suh I, Duh QY, Finlayson E. Patient Frailty Should Be Used to Individualize Treatment Decisions in Primary Hyperparathyroidism. World J Surg 2018; 42:3215-3222. [PMID: 29696330 DOI: 10.1007/s00268-018-4629-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is a common endocrine disorder that predominantly affects patients >60 and is increasing in prevalence. Identifying risk factors for poor outcomes after parathyroidectomy in older adults will help tailor operative decision making. The impact of frailty on surgical outcomes in parathyroidectomy has not been established. METHODS We performed a retrospective review of patients ≥40 years who underwent parathyroidectomy in the 2005-2010 ACS NSQIP. Frailty was assessed using the modified frailty index (mFI). Multivariable regression was used to determine the association of frailty with 30-day complications, length of stay (LOS), and reoperation. RESULTS We identified 13,123 patients ≥40 who underwent parathyroidectomy for PHPT. The majority of patients were not frail, with 80% with a low NSQIP mFI score (0-1 frailty traits), 19% with an intermediate mFI score (2-3), and 0.9% with a high mFI score (≥4). Overall 30-day complications were rare, occurring in 141 (1.1%) patients. Increasing frailty was associated with an increased risk of complications with adjusted odds ratios (ORs) of 1.76 (95% CI 1.20-2.59; p = 0.004) for intermediate and 8.43 (95% CI 4.33-16.41; p < 0.001) for high mFI score. Patient age was independently associated with an increased risk of complications only when ≥75, as was African-American race. Anesthesia with local, monitored anesthesia care, or regional block was the only factor associated with decreased odds of complications. A high NSQIP mFI was also associated with a significant 4.77-day adjusted increase in LOS (95% CI 4.28-5.25; p < 0.001) and increased odds of reoperation (OR 4.20, 95% CI 1.64-10.74; p = 0.003). CONCLUSION Patient frailty is associated with increased complications, reoperation and prolonged LOS in patients undergoing parathyroidectomy for PHPT. The risks of surgical management should be weighed against potential benefits in frail patients with PHPT to individualize treatment decisions in this vulnerable population.
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Affiliation(s)
- Carolyn D Seib
- Department of Surgery, University of California, San Francisco, 1600 Divisadero Street, 4th Floor, Box 1674, San Francisco, CA, 94143, USA.
| | - Kathryn Chomsky-Higgins
- Department of Surgery, University of California, San Francisco, 1600 Divisadero Street, 4th Floor, Box 1674, San Francisco, CA, 94143, USA
| | - Jessica E Gosnell
- Department of Surgery, University of California, San Francisco, 1600 Divisadero Street, 4th Floor, Box 1674, San Francisco, CA, 94143, USA
| | - Wen T Shen
- Department of Surgery, University of California, San Francisco, 1600 Divisadero Street, 4th Floor, Box 1674, San Francisco, CA, 94143, USA
| | - Insoo Suh
- Department of Surgery, University of California, San Francisco, 1600 Divisadero Street, 4th Floor, Box 1674, San Francisco, CA, 94143, USA
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco, 1600 Divisadero Street, 4th Floor, Box 1674, San Francisco, CA, 94143, USA
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, 1600 Divisadero Street, 4th Floor, Box 1674, San Francisco, CA, 94143, USA
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Calò PG, Medas F, Loi G, Pisano G, Sorrenti S, Erdas E, Nicolosi A. Parathyroidectomy for primary hyperparathyroidism in the elderly: experience of a single endocrine surgery center. Aging Clin Exp Res 2017; 29:15-21. [PMID: 27837463 DOI: 10.1007/s40520-016-0666-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary hyperparathyroidism is a common endocrine disease, and its incidence increases with age. AIMS Our aim was to retrospectively evaluate the impact of age on patient outcomes following parathyroidectomy for primary hyperparathyroidism. METHODS Two-hundred fifty-six consecutive patients undergoing parathyroidectomy with preoperative diagnosis of primary hyperparathyroidism were divided into three groups according to patient age: group A, ≤64 years; group B, 65-74 years; and group C, ≥75 years. RESULTS Thyroid disease was associated with the hyperparathyroidism in 44 patients (28.2%) in group A, 34 (44.7%) in B, and 10 (41.7%) in C (p < 0.01). Minimally invasive parathyroidectomy was performed in 104 patients (66.7%) in group A, 35 (46.1%) in B, and 8 (33.3%) in C (p < 0.01). Conversion to bilateral exploration was carried out in five cases in group A (4.6%), three in B (8.3%), and two in C (20%). Multiglandular disease was observed in six patients (3.8%) in group A, seven (9.2%) in B, and five (20.8%) in C (p = 0.012). Mean postoperative stay was similar between groups; no major complications and no cases of mortality occurred. DISCUSSION Multiglandular disease is more common in older patients than younger individuals, and minimally invasive approaches are less used in this patient group. Increased surgical risk and paucity of symptoms in these patients sometimes result in a delay in surgical treatment. CONCLUSIONS Parathyroidectomy is a safe and effective procedure to perform in elderly patients. Multiglandular disease was found to be more prevalent in older patients, but minimally invasive parathyroidectomy can be performed safely. Surgeons should consider parathyroidectomy in patients with primary hyperparathyroidism regardless of age.
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Affiliation(s)
- Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy.
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Giulia Loi
- Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Giuseppe Pisano
- Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Angelo Nicolosi
- Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy
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Lou I, Balentine C, Clarkson S, Schneider DF, Sippel RS, Chen H. How long should we follow patients after apparently curative parathyroidectomy? Surgery 2016; 161:54-61. [PMID: 27863779 DOI: 10.1016/j.surg.2016.05.049] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/07/2016] [Accepted: 05/11/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little is known about the long-term recurrence risk for primary hyperparathyroidism after immediately "curative" parathyroidectomy. This study aimed to evaluate the risk of recurrent hyperparathyroidism in the 10 years after operation. METHOD We retrospectively identified patients with sporadic primary hyperparathyroidism undergoing initial parathyroidectomy between November 1, 2000 and June 30, 2005. Recurrence was defined as serum calcium >10.2 mg/dL after 6 months from operation. Kaplan-Meier estimates and Cox proportional hazards were used to evaluate disease-free survival and predictors of recurrence. RESULTS We evaluated 196 patients with a 14.8% 10-year recurrence rate. Median time to recurrence was 6.3 years (interquartile range 3.4-10.8 years), and 34.5% of all recurrences were identified >10 years after operation. There was no difference in recurrence between open and minimally invasive operation (P = .448). Double adenomas (P = .006), intraoperative parathyroid hormone drop <70% (P = .015), and young age (P = .032) were predictive of disease recurrence. Multivariable analysis demonstrated that older age was protective against recurrence (hazard ratio 0.97, 95% confidence interval 0.94-0.99, P = .034), while double adenomas (hazard ratio 3.52, 95% confidence interval 1.23-10.08, P = .019) were an independent predictor for recurrence. CONCLUSION The long-term recurrence rate for sporadic primary hyperparathyroidism after "curative" parathyroidectomy is likely greater than reported. With over one-third of our institutional recurrences at >10 years after the initial operation, long-term follow-up is essential.
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Affiliation(s)
- Irene Lou
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Courtney Balentine
- Department of Surgery, University of Wisconsin, Madison, WI; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
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Affiliation(s)
- Beatrice Wong
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Xiangbing Wang
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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Hyperparathyroidism in octogenarians: A plea for ambulatory minimally invasive surgery under local anesthesia. ANNALES D'ENDOCRINOLOGIE 2016; 77:600-605. [DOI: 10.1016/j.ando.2015.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/08/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022]
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Surgical treatment of concomitant thyroid and parathyroid disorders: analysis of 4882 cases. Eur Arch Otorhinolaryngol 2016; 274:997-1004. [PMID: 27619822 DOI: 10.1007/s00405-016-4303-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022]
Abstract
The thyroid gland disease incidence in hyperparathyroidism (HPT) is higher than the incidence of thyroid disease in general population. Likewise, HPT is more frequent in patients primary admitted due to thyroid disease, than in general population. The aim of this study was to determine the incidence and clinical characteristics of concomitant HPT and thyroid disease, based on a single center experience. From 2009 to 2014, a total of 4882 patients underwent thyroidectomy and/or parathyroidectomy at the Center for Endocrine Surgery, Belgrade. We reviewed the database to find out indications for surgery, clinical characteristics, operative and histopathological findings. Out of 4033 patients, who underwent thyroidectomy, in 114 cases (2.8 %) parathyroidectomy was simultaneously performed. Out of these 114 patients, 42 patients (37 %) had normocalcemic HPT. Among 849 patients primary operated due to HPT, thyroid gland disease that required surgery was found in 224 (26.4 %). In patients primary seen for HPT, thyroid cancer was found in 22 (9.8 %), Hashimoto's thyroiditis in 41 (18.3 %) and micropapillary carcinoma in 36 cases (16.1 %). Due to residual or recidivant HPT, 16 patients (15 who primary underwent parathyroidectomy and 1 primary seen for thyroid disease) needed a reoperation. There are a considerable number of patients with concomitant thyroid and parathyroid disease; this justifies the routine analyses of calcemia and PTH level in patients preparing for thyroidectomy, and sets up the ground for the thyroid investigations in HPT.
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Dulfer R, Geilvoet W, Morks A, van Lieshout EM, Smit CP, Nieveen van Dijkum EJ, in't Hof K, van Dam F, van Eijck CH, de Graaf PW, van Ginhoven TM. Impact of parathyroidectomy for primary hyperparathyroidism on quality of life: A case-control study using Short Form Health Survey 36. Head Neck 2016; 38:1213-20. [DOI: 10.1002/hed.24499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Roderick Dulfer
- Department of Surgery; Erasmus MC; Rotterdam The Netherlands
| | - Wanda Geilvoet
- Department of Surgery; Erasmus MC; Rotterdam The Netherlands
| | - Annelien Morks
- Department of Surgery; Groene Hart Ziekenhuis; Gouda The Netherlands
| | | | - Casper P.C Smit
- Department of Surgery; Reinier de Graaf Groep (RDGG) Hospital; Delft The Netherlands (retired)
| | | | - Klaas in't Hof
- Department of Surgery; Flevoziekenhuis; Almere The Netherlands
| | | | | | - Peter W. de Graaf
- Department of Surgery; Reinier de Graaf Groep (RDGG) Hospital; Delft The Netherlands (retired)
| | - Tessa M. van Ginhoven
- Department of Surgery; Reinier de Graaf Groep (RDGG) Hospital; Delft The Netherlands (retired)
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Crouzeix G, Kerlan V. Hyperparathyroïdie primaire : nouveaux concepts, nouvelles recommandations. ANNALES D'ENDOCRINOLOGIE 2014; 75 Suppl 1:S21-36. [DOI: 10.1016/s0003-4266(14)70024-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Denizot A, Grino M, Oliver C. Surgical management of primary hyperparathyroidism in older adults. J Am Geriatr Soc 2014; 62:1759-63. [PMID: 25113865 DOI: 10.1111/jgs.12968] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the feasibility, safety, and outcome of parathyroidectomy in the management of primary hyperparathyroidism (PHPT) in individuals aged 75 and older with that of those younger than 50. DESIGN Retrospective chart review. SETTING Department of Endocrine Surgery, Hospital Paul Desbief (Marseille, France). PARTICIPANTS Individuals who underwent surgery from June 2005 to February 2013 (N = 526) had a clinical examination and laboratory and imaging assessments to diagnose PHPT. MEASUREMENTS The clinical and biochemical characteristics and surgery outcomes of individuals younger than 50 (n = 80) were compared with the characteristics and outcomes of those aged 75 and older (n = 89). RESULTS Most of the participants did not have any specific signs of PHPT, and the diagnosis of PHPT was established in some participants during routine clinical and laboratory examination. Nephrolithiasis and osteitis fibrosa cystica were observed only in the younger group. Urinary calcium decreased with age. Nine participants aged 75 and older did not undergo surgery (four declined, five had medical contraindications). Conventional surgery through transverse cervicotomy was used in the majority of participants. Cure rate was excellent (158/160), with few and reversible minor complications. The coexistence of thyroid lesions was significantly higher in the older (47.5%) than in the younger group (32.3%). Nodules and multinodular goiters were removed in the majority of participants during the parathyroidectomy procedure. CONCLUSION With the exception of a few cases with severe associated comorbidities, parathyroidectomy is safe and curative and should be considered as first-line choice for older adult with PHPT.
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Affiliation(s)
- Anne Denizot
- Department of Endocrine Surgery, European Hospital, Marseille, France
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Blanchard C, Mathonnet M, Sebag F, Caillard C, Kubis C, Drui D, van Nuvel E, Ansquer C, Henry JF, Masson D, Kraeber-Bodéré F, Hardouin JB, Zarnegar R, Hamy A, Mirallié E. Quality of life is modestly improved in older patients with mild primary hyperparathyroidism postoperatively: results of a prospective multicenter study. Ann Surg Oncol 2014; 21:3534-40. [PMID: 24823444 DOI: 10.1245/s10434-014-3731-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objectives of this study were to evaluate, in mild primary hyperparathyroidism (pHPT) patients, the quality of life (QoL) using the SF-36 questionnaire before and after parathyroidectomy and to detect preoperatively patients who benefit the most from surgery. Most pHPT patients present a mild pHPT defined by calcemia ≤11.4 mg/dL. For these patients, there is debate about whether they should be managed with surveillance, medical therapy, or surgery. METHODS A prospective multicenter study investigated QoL (SF-36) in patients with mild pHPT before and after parathyroidectomy in four university hospitals. Laboratory results and SF-36 scores were obtained preoperatively and postoperatively (3, 6, and 12 months). RESULTS One hundred sixteen patients were included. After surgery, the biochemical cure rate was 98%. Preoperatively, the mental component summary and the physical component summary (PCS) were 38.69 of 100 and 39.53 of 100, respectively. At 1 year, the MCS and the PCS were 41.29 of 100 and 42.03 of 100. The subgroup analysis showed a more significant improvement in patients < 70 years and with calcemia ≥10.4 mg/dL. Postoperative PCS was correlated with age and preoperative PCS: variation = 32.11 - 0.21 × age - 0.4 × preoperative PCS. Men did not improve their MCS postoperatively. Only women with a preoperative MCS <43.6 of 100 showed postoperative improvement. CONCLUSIONS This study showed, in patients with mild pHPT, an improvement of QoL 1 year after parathyroidectomy. Patients <70 years and with calcemia ≥10.4 mg/dL had a more significant improvement.
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Affiliation(s)
- Claire Blanchard
- Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalier Universitaire Nantes-Hôtel Dieu, Nantes, France
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Mekel M, Gilshtein H, Chapchay K, Bishara B, Krausz MM, Freund HR, Kluger Y, Eid A, Mazeh H. Parathyroid Surgery in the Elderly: Should Minimally Invasive Surgery Be Abandoned? Ann Surg Oncol 2013; 21:1369-73. [DOI: 10.1245/s10434-013-3402-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Indexed: 11/18/2022]
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Murray SE, Pathak PR, Pontes DS, Schneider DF, Schaefer SC, Chen H, Sippel RS. Timing of symptom improvement after parathyroidectomy for primary hyperparathyroidism. Surgery 2013; 154:1463-9. [PMID: 24238059 DOI: 10.1016/j.surg.2013.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 09/30/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND The timing of symptom improvement after parathyroidectomy for primary hyperparathyroidism (PHPT) has not been well characterized. METHODS This prospective study involved administering a questionnaire to patients with PHPT who underwent curative parathyroidectomy over an 11-month period. The questionnaire evaluated the frequency of 18 symptoms of PHPT on a 5-point Likert scale and was administered preoperatively and 1 week, 6 weeks, and 6 months postoperatively. RESULTS Of 197 eligible patients, 132 (67%) participated in the study. The questionnaires were completed at a rate of 91%, 92%, and 86% at 1 week, 6 weeks, and 6 months postoperatively, respectively. The most commonly reported preoperative symptoms were fatigue (98%), muscle aches (89%), and bone/joint pain (87%). Improvement in symptom severity occurred across all symptoms and was separated into three categories based on the timing of improvement. Fatigue and bone/joint pain demonstrated "Immediate Improvement" (>50% of patients reporting improvement by post-operative week 1), whereas the majority of symptoms showed peak improvement at 6 weeks ("Delayed Improvement"). Symptoms categorized as "Continuous Improvement" were those showing progressive improvement up to 6 months postoperatively (polydipsia, headaches, and nausea/vomiting). CONCLUSION Symptom improvement was most prominent 6 weeks postparathyroidectomy, although some symptoms showed continued improvement at 6 months.
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Affiliation(s)
- Sara E Murray
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI
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Oltmann SC, Schneider DF, Sippel RS, Chen H. Presentation, Management, and Outcomes of Hyperparathyroidism in Octogenarians and Nonagenarians. Ann Surg Oncol 2013; 20:4195-9. [DOI: 10.1245/s10434-013-3187-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Indexed: 01/19/2023]
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Incidence of concomitant hyperparathyroidism in patients with thyroid disease requiring surgery. J Surg Res 2012; 178:264-7. [PMID: 22482770 DOI: 10.1016/j.jss.2012.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 02/02/2012] [Accepted: 03/08/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Thyroid disease and hyperparathyroidism (HPT) are among the most common endocrine disorders, however, their association has not been well established. The aim of the present study was to determine the incidence of concomitant HPT in patients with thyroid disease requiring surgery, because a single definitive surgery should ideally be performed. METHODS We retrospectively reviewed a prospectively maintained database of patients who underwent thyroidectomy at a single institution. Data collected included the patients' initial indication for surgery, preoperative workup, and operative findings. RESULTS Of the 1,049 patients who underwent thyroidectomy, 56 (5%) had concomitant HPT and underwent simultaneous parathyroidectomy. Of these 56 patients, 36 initially presented with thyroid disease and 20 with HPT. The mean age was 59 ± 2 years, and 79% were women. The mean preoperative calcium and parathyroid hormone levels were elevated at 10.4 ± 0.1 mg/dL and 87 ± 7 pg/mL, respectively. Most of these patients had primary HPT (n = 54, 96%). Of the 36 patients presenting initially with thyroid disease, 26 had an elevated calcium or parathyroid hormone value and were preoperatively diagnosed with HPT. The remaining 10 patients had normal laboratory findings; however, a pathologically enlarged parathyroid gland was found at thyroidectomy. The overall cure rate for HPT within our series was 96%. CONCLUSION The incidence of concomitant HPT in patients with thyroid disease requiring surgery is significant at 5%. Recognition of concurrent disease is important, because it allows for a single definitive surgery to treat both pathologies.
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Thomas DC, Roman SA, Sosa JA. Parathyroidectomy in the Elderly: Analysis of 7313 Patients. J Surg Res 2011; 170:240-6. [DOI: 10.1016/j.jss.2011.03.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 02/13/2011] [Accepted: 03/03/2011] [Indexed: 11/15/2022]
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Zenilman ME, Chow WB, Ko CY, Ibrahim AM, Makary MA, Lagoo-Deenadayalan S, Dardik A, Boyd CA, Riall TS, Sosa JA, Tummel E, Gould LJ, Segev DL, Berger JC. New Developments in Geriatric Surgery. Curr Probl Surg 2011; 48:670-754. [DOI: 10.1067/j.cpsurg.2011.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
The prevalence of primary hyperparathyroidism (PHPT) will increase with the growth of the elderly population. Elderly patients primarily present with nonclassic symptoms of PHPT that can sometimes be missed in favor of other diagnoses. Several recent studies demonstrate the safety and efficacy of outpatient, minimally invasive parathyroidectomy in elderly patients with PHPT, the majority of them reporting increased fracture-free survival and symptomatic relief postoperatively and thus experiencing improved quality of life. Introduction. The prevalence of primary hyperparathyroidism (PHPT) is expected to increase in developed nations as the aged population grows. This review discusses issues related to PHPT in the elderly population with a focus on differences in disease presentation, medical and surgical management, and outcomes. Methods. Literature review of English-language studies of PHPT or parathyroidectomy (PTx) in the elderly was performed. Surgical literature reviewed included original clinical studies published after 1990. Priority was given to studies with >30 patients where institutional practice and outcomes have not changed significantly over time. Results. Elderly patients primarily present with nonclassic symptoms of PHPT that can sometimes be missed in favor of other diagnoses. They have equivalent surgical outcomes, including morbidity, mortality, and cure rates, compared with younger patients, although their length of hospital stay is significantly longer. Several recent studies demonstrate the safety and efficacy of outpatient, minimally invasive parathyroidectomy in an elderly population. Patients are referred for PTx less frequently with each advancing decade, although surgical referral patterns have increased over time in centers that offer minimally invasive parathyroidectomy. Elderly patients experience increased fracture-free survival after PTx. The majority of elderly patients report symptomatic relief postoperatively. Conclusion. PTx can offer elderly patients with PHPT improved quality of life. PTx is safe and effective in elderly patients, and advanced age alone should not deter surgical referral.
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Affiliation(s)
- Lilah F. Morris
- Endocrine Surgical Unit, Department of General Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Juliette Zelada
- Endocrine Surgical Unit, Department of General Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Bian Wu
- Endocrine Surgical Unit, Department of General Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Theodore J. Hahn
- VA Greater Los Angeles Geriatric Research, Education and Clinical Center and Division of Geriatric Medicine, Los Angeles, California, USA
| | - Michael W. Yeh
- Endocrine Surgical Unit, Department of General Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Affiliation(s)
- Joel T Adler
- Intern in General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Wu B, Haigh PI, Hwang R, Ituarte PHG, Liu ILA, Hahn TJ, Yeh MW. Underutilization of parathyroidectomy in elderly patients with primary hyperparathyroidism. J Clin Endocrinol Metab 2010; 95:4324-30. [PMID: 20610600 PMCID: PMC2936062 DOI: 10.1210/jc.2009-2819] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) disproportionately affects older patients, who may face higher thresholds for surgical intervention compared to young patients. OBJECTIVE The aim was to examine for differences in the utilization of parathyroidectomy attributable to age. DESIGN We conducted a retrospective cohort study. PARTICIPANTS Patients with biochemically diagnosed PHPT during the years 1995-2008 were identified within an integrated health care delivery system in Southern California encompassing approximately 3 million individuals. MAIN OUTCOME MEASURES The outcome measures were parathyroidectomy (PTx) and time interval to surgery. RESULTS We found 3388 patients with PHPT, 964 (28%) of whom underwent PTx. Patients aged 60+ yr comprised 60% of the study cohort. The likelihood of PTx decreased linearly among patients aged 60+ when compared to patients aged 50-59, an effect that persisted in multivariate analysis: odds ratio 0.68 for ages 60-69 (P < 0.05); 0.41 for ages 70-79 (P < 0.0001), and 0.11 for age 80+ (P < 0.0001). The PTx rate for patients aged 70+ was 14%. Among patients meeting 2002 consensus criteria for surgical treatment, 45% of those aged 60-69 and 24% of those aged 70+ underwent PTx. A Cox proportional hazards model showed that patients aged 60+ experienced significantly longer delays from diagnosis to surgery compared to young patients (P < 0.0001). CONCLUSIONS PHPT is undertreated in the elderly. We observed a progressive age-related decline in PTx rate that renders patients aged 70+ unlikely to have definitive treatment, irrespective of comorbidity and eligibility for surgery.
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Affiliation(s)
- Bian Wu
- Endocrine Surgical Unit, Department of Surgery, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California 90095, USA
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Persistent symptomatic improvement in the majority of patients undergoing parathyroidectomy for primary hyperparathyroidism. Langenbecks Arch Surg 2010; 395:941-6. [PMID: 20658300 DOI: 10.1007/s00423-010-0689-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 07/05/2010] [Indexed: 10/19/2022]
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.
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Adler JT, Sippel RS, Chen H. 25-Hydroxyvitamin D Status Does Not Affect Intraoperative Parathyroid Hormone Dynamics in Patients with Primary Hyperparathyroidism. Ann Surg Oncol 2010; 17:2958-62. [DOI: 10.1245/s10434-010-1125-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Indexed: 12/12/2022]
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A rising ioPTH level immediately after parathyroid resection: are additional hyperfunctioning glands always present? An application of the Wisconsin Criteria. Ann Surg 2010; 251:1127-30. [PMID: 20485151 DOI: 10.1097/sla.0b013e3181d3d264] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was designed to determine if a rising intraoperative parathyroid hormone (ioPTH) level following parathyroid resection indicates multiple hyperfunctioning glands and to determine the appropriate intraoperative management. SUMMARY BACKGROUND DATA IoPTH monitoring is commonly used to guide parathyroid surgery. A significant rise in the ioPTH immediately after resection of a single parathyroid is often perceived to be indicative of the presence of additional hyperfunctioning glands. METHODS A total of 797 consecutive patients underwent parathyroidectomy for primary hyperparathyroidism with ioPTH monitoring. Patients with an elevated 5 minute ioPTH were extensively studied. Operative success was defined as normocalcemia 6 months after surgery. RESULTS Of the 797 patients, 108 (14%) had a rising ioPTH 5 minutes after resection of a single parathyroid. Of these 108 patients, 36 (33%) continued to have elevated ioPTH levels and further exploration revealed additional hyperfunctioning glands. Importantly, in the majority of patients (n = 72 or 67%), the ioPTH started to fall after an additional 5 minutes (10 minutes after resection). The ioPTH declined by more than 50% from the 5 minute elevated value in 30%, 89%, and 99% of patients at 10, 15, and 20 minutes after resection, respectively. Importantly, this fall correctly predicted operative success in 100% of patients after removal of a single abnormal gland. CONCLUSIONS A rising ioPTH level immediately after parathyroidectomy is observed in 14% of patients. The majority of these patients do not have additional hyperfunctioning glands. Most of patients fell below 50% of the 5 minute elevated value within 20 minutes of gland resection and in all cases this fall correctly predicted operative success.
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Stechman MJ, Weisters M, Gleeson FV, Sadler GP, Mihai R. Parathyroidectomy is safe and improves symptoms in elderly patients with primary hyperparathyroidism (PHPT). Clin Endocrinol (Oxf) 2009; 71:787-91. [PMID: 19222492 DOI: 10.1111/j.1365-2265.2009.03540.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Parathyroidectomy for primary hyperparathyroidism (PHPT) is curative in over 95% of cases. Although PHPT affects up to 2% of the elderly population, whose life expectancy may be a decade or more, such patients may be denied surgery because of perceived risk. This study investigates the outcomes of surgery for PHPT in the elderly. DESIGN AND PATIENTS Consecutive patients with PHPT treated at a tertiary referral centre over 5 years. MEASUREMENTS A prospective database recorded clinical, biochemical and pathological information. Pasieka's parathyroid symptom scores were obtained pre-operatively and post-operatively, from a recent subgroup of 70 consecutive patients. Deaths during follow-up were identified using the NHS Strategic Tracing Service. Statistical analysis was performed with spss v12.0. RESULTS Between November 2002 and October 2007, 224 patients (17-89 years) underwent surgery for PHPT. In the subgroup comprising patients aged >75 years there was a significantly greater proportion of women (47/56 vs. 52/81, P < 0.05). Pre-operative indices of these patients were similar to younger patients, as were proportions undergoing minimally invasive parathyroidectomy (n = 134) or bilateral neck exploration (n = 90). Patients >75 years had a longer hospital stay (1.6 vs. 0.8 days, P = 0.003). Pasieka's symptom scores improved significantly at 3-6 months postoperatively in all age groups. During a minimum median follow-up of 22 months, there were seven patients with persistent/recurrent disease. Median 2-year survival of those aged 60-74 and those over 75 ranged from 85-90%. CONCLUSION Parathyroidectomy is safe in the elderly and is associated with a significant improvement in symptoms. As survival after operation is similar to younger patients, surgery should be considered in all elderly patients with PHPT.
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Harrison B. Commentary on 'Parathyroidectomy is safe and improves symptoms in elderly patients with primary hyperparathyroidism (PHPT)'. Clin Endocrinol (Oxf) 2009; 71:766-7. [PMID: 19341438 DOI: 10.1111/j.1365-2265.2009.03601.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Barney Harrison
- Department of Endocrine Surgery, Sheffield Teaching Hospitals, NHS Trust, Sheffield S10 2JF, UK.
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Young VN, Osborne KM, Fleming MM, Flynn MB, Goldstein RE, Bumpous JM. Parathyroidectomy in the elderly population: Does age really matter? Laryngoscope 2009; 120:247-52. [DOI: 10.1002/lary.20706] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Outpatient minimally invasive parathyroidectomy is safe for elderly patients. J Am Coll Surg 2009; 208:1071-6. [PMID: 19476894 DOI: 10.1016/j.jamcollsurg.2009.01.048] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 01/16/2009] [Accepted: 01/20/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND Elderly patients with primary hyperparathyroidism (PHPT) are often not referred for surgical intervention because of concern of comorbid conditions that may increase perioperative complications. Because PHPT is more common in the elderly, we sought to compare indications and complications of minimally invasive parathyroidectomy in patients 70 years of age and older (elderly) with their younger counterparts. STUDY DESIGN A review was conducted of a prospectively collected database of all patients undergoing parathyroidectomy on our endocrine surgery service. Data collected included patient demographic, biochemical pathologic, and operative findings. Wilcoxon rank sum and chi-square tests were used for comparisons. RESULTS Three hundred eighty-eight patients with PHPT recently underwent parathyroidectomy over a 3-year period (elderly, n=101; younger, n=287). The elderly cohort had significantly higher median preoperative creatinine (elderly, 2.0 mg/dL; younger,1.0 mg/dL; p=0.002) and parathyroid hormone (elderly, 145 pg/mL; younger, 123 pg/mL; p=0.026) levels. The elderly cohort also had more severe osteoporosis, with a significantly worse median bone mineral density T-score (elderly, -2.5; younger, -1.8; p<0.001). The rate of postoperative complications was similarly low in both groups (elderly, 5.9%; younger, 3.5%; p=0.38). CONCLUSIONS Minimally invasive parathyroidectomy for PHPT can be performed as safely in elderly patients as in their younger counterparts. Elderly patients with PHPT are more likely to have osteoporosis and higher creatinine levels at the time of surgical referral. Additional study of the role of earlier intervention is warranted.
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Ning L, Sippel R, Schaefer S, Chen H. What is the Clinical Significance of an Elevated Parathyroid Hormone Level After Curative Surgery for Primary Hyperparathyroidism? Ann Surg 2009; 249:469-72. [DOI: 10.1097/sla.0b013e31819a6ded] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Surgery improves quality of life in patients with “mild” hyperparathyroidism. Am J Surg 2009; 197:284-90. [DOI: 10.1016/j.amjsurg.2008.09.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 09/01/2008] [Accepted: 09/02/2008] [Indexed: 11/15/2022]
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Adler JT, Sippel RS, Schaefer S, Chen H. Preserving function and quality of life after thyroid and parathyroid surgery. Lancet Oncol 2008; 9:1069-75. [PMID: 19012855 DOI: 10.1016/s1470-2045(08)70276-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Endocrine disease has been recognised for thousands of years, but surgical treatment of endocrine disorders has only been widely used in the past century. Surgery is an effective treatment for hyperfunctioning glands and benign and malignant tumours. Advances in surgical technique have led to the development of short and safe operations with a high cure rate, and recent studies have not only assessed the success of the operations but also have focused on how these diseases affect patient-reported quality of life before and after surgery. In this Review, we summarise current approaches to surgical treatment of thyroid and parathyroid disease, focusing on how these approaches both preserve function and improve quality of life after surgery.
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Affiliation(s)
- Joel T Adler
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Pasieka's parathyroid symptoms scores correlate with SF-36 scores in patients undergoing surgery for primary hyperparathyroidism. World J Surg 2008; 32:807-14. [PMID: 18324348 DOI: 10.1007/s00268-008-9509-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Parathyroidectomy for primary hyperparathyroidism (PHPT) is expected to trigger an improvement in the quality of life. This has been demonstrated previously by using the SF-36 questionnaire, whose interpretation is difficult in routine clinical practice. As an alternative, the 13-item questionnaire developed by Pasieka et al. can be used to assess the severity of symptoms on a visual analogue from which a parathyroid assessment of symptoms score (PAS) can be calculated. The purpose of this study was to correlate results of these two assessment tools. METHODS Prospective case-series study recruiting consecutive unselected patients who underwent successful parathyroidectomy for PHPT. SF-36(v2) and Pasieka's questionnaires were collected before parathyroidectomy and at 3, 6, and 12 months postoperatively. RESULTS Between November 2005 and December 2006, 101 patients were diagnosed with PHPT (30 men; aged 18-89 years). Preoperative PAS ranged 0-1040 and did not correlate with the severity of hypercalcemia (2.91+/-0.25; range, 2.56-3.4 mmol/l). Scores from the SF-36 questionnaire were under the 50th percentile for the normal population in three domains (vitality, emotional role, and physical role). Minimally invasive parathyroidectomy was performed in 69 patients and bilateral cervical exploration in 32 patients. All were found to have a single parathyroid adenoma and were normocalcemic at 3-12 months after parathyroidectomy. At follow-up, there was a significant reduction of PAS from 460+/-257 preoperatively to 254+/-234 at 3 months postoperatively (n=72), to 245+/-215 at 6 months (n=50), and 249+/-212 at 12 months (n=63) (p<0.05, Student's t-test). There was a significant and persistent improvement in five domains of SF-36 questionnaire: bodily pain, general health, vitality, social functioning and mental health. Overall analysis of 244 assessments using both questionnaires demonstrated a negative correlation between increasing PAS and decreasing mental component scores and physical component scores of the SF-36 assessment (r2=0.372 and 0.301, respectively). CONCLUSIONS Pasieka's parathyroid assessment of symptom scores (PAS) correlate with SF-36 questionnaire scores. Because PAS allows easier and faster analysis, we advocate that Pasieka's questionnaire should be integrated into the assessment of patients with PHPT as a reliable tool to identify symptomatic changes that correlate with improved quality of life.
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Adler JT, Sippel RS, Chen H. The Influence of Surgical Approach on Quality of Life After Parathyroid Surgery. Ann Surg Oncol 2008; 15:1559-65. [DOI: 10.1245/s10434-008-9879-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 02/17/2008] [Accepted: 02/17/2008] [Indexed: 11/18/2022]
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