Elevated parathyroid hormone after parathyroidectomy delays symptom improvement

Area of Science:

• Endocrinology
• Surgical Oncology
• Neurosurgery

Background:

• Primary hyperparathyroidism (PHPT) is often treated with parathyroidectomy, which can resolve disease-related symptoms.
• A significant percentage of patients (8-40%) exhibit persistently elevated parathyroid hormone (ePTH) levels post-surgery, even with normal calcium levels.
• The impact of early postoperative ePTH on the timeline of symptom resolution remains unclear.

Purpose of the Study:

• To investigate the association between early postoperative ePTH and the timing of symptom improvement following parathyroidectomy for PHPT.
• To determine if ePTH influences the rate at which patients experience relief from PHPT-related symptoms.

Main Methods:

• A prospective study involving adult PHPT patients undergoing curative parathyroidectomy.
• Patients were categorized based on parathyroid hormone (PTH) levels at 2 weeks post-surgery: ePTH (>72 pg/mL) versus normal PTH (nPTH).
• Symptom frequency was assessed using a pre- and post-operative questionnaire (6 weeks and 6 months) with a five-point Likert scale for 18 symptoms.

Main Results:

• Of 129 participants, 16% (20 patients) had ePTH at 2 weeks post-surgery.
• At 6 weeks post-surgery, the ePTH group reported less improvement in 14 of 18 symptoms compared to the nPTH group.
• Statistically significant differences in symptom improvement were observed for anxiety, constipation, thirst, and polyuria in the ePTH group at 6 weeks.

Conclusions:

• Persistently elevated parathyroid hormone (ePTH) in the early postoperative period following parathyroidectomy may lead to a delay in symptom resolution.
• This delay in symptom improvement is temporary, with symptom profiles becoming comparable between ePTH and nPTH groups by 6 months post-surgery.