Back to my future: life after surgery for tertiary hyperparathyroidism

Area of Science:

• Endocrinology
• Nephrology
• Surgical Oncology

Background:

• Tertiary hyperparathyroidism (THPT) is a common complication in patients with chronic kidney disease.
• THPT can lead to significant morbidity and reduced quality of life.
• Surgical management via parathyroidectomy is a definitive treatment option for THPT.

Purpose of the Study:

• To evaluate the impact of parathyroidectomy on quality of life (QoL) in patients with THPT.
• To assess changes in disease-specific and non-specific symptoms using the Parathyroidectomy Assessment of Symptoms (PAS) and Short Form-36 (SF-36) questionnaires.

Main Methods:

• A single-centre, longitudinal retrospective analysis of 34 THPT patients who underwent parathyroidectomy between 2015 and 2021.
• The PAS and SF-36 questionnaires were administered pre-operatively and 24 months post-discharge.
• Predictors of QoL changes were identified, including pre-operative intact parathormone (iPTH) levels, T-score, and duration of haemodialysis.

Main Results:

• Significant improvements in QoL were observed across physical SF-36 (42.4 to 56.7) and mental SF-36 (47.3 to 61.8) scores (P < 0.001).
• The PAS score demonstrated a significant reduction (582 to 293; P < 0.001), indicating amelioration of all 13 assessed symptoms.
• Pre-operative iPTH, T-score, and haemodialysis duration predicted changes in PAS and mental SF-36 scores.

Conclusions:

• Parathyroidectomy effectively ameliorates disease-related and non-specific symptoms in THPT patients, leading to a significant QoL improvement.
• The study recommends integrating symptom assessment scales into routine evaluations for tailored patient management.
• This approach can optimize diagnosis and future treatment strategies for THPT.