Surgical treatment of primary hyperparathyroidism in elderly patients

Surgical treatment of hyperparathyroidism is often withheld from elderly patients out of concern about operative morbidity and mortality. We reviewed the case records of 81 patients over the age of 65 who underwent neck exploration for primary hyperparathyroidism at the University of Michigan Medical Center during the past 10 years. The most common presenting symptoms were lethargy (62%), neurological complaints (44%), and constipation (42%). Less common were histories of peptic ulcer disease (30%) and renal lithiasis (25%). Delay from time of diagnosis to operation averaged 33 weeks. Seventy-seven percent had adenomas, of which 9% were multiple. Average postoperative hospital stay was 7.1 days, ranging from 3 to 22 days. There was no mortality. We believe that neck exploration for primary hyperparathyroidism can be safely performed in elderly patients and should not be delayed or withheld merely on the basis of advanced age.