Psychologic symptoms before and after parathyroid surgery

To identify in an outpatient setting the type and number of psychologic symptoms of patients with primary hyperparathyroidism before and after surgery.

A convenience sample of 18 patients with primary hyperparathyroidism and a comparison sample of 20 patients with benign thyroid disease were scheduled by their primary care physician to have surgery. Assessments of psychologic symptoms, using the Symptom Checklist-90-Revised, and measurements of serum total calcium, ionized calcium, parathyroid hormone, albumin, alkaline phosphatase, urea nitrogen, creatinine, protein, and phosphate were obtained preoperatively. and at 1, 3, and 6 months postoperatively.

The hyperparathyroid group had significantly higher (p < 0.01) levels of total and ionized serum calcium and parathyroid hormone preoperatively, with biochemical normalization 1 month postoperatively. These patients showed multidimensional psychologic symptom distress preoperatively in the areas of obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, and psychoticism; they also had a greater number and intensity of distressful symptoms. Paranoid ideation was significantly higher in the hyperparathyroid group than in the comparison group, but it did not quite reach the clinical range. The greatest improvement in symptoms occurred by 1 month after surgery, with the hyperparathyroid group approaching the normative mean. There were no group differences before or after surgery for the areas of somatization and phobic anxiety.

The Symptom Checklist-90-Revised is a simple, quick, and cost-effective way to quantitatively assess the psychologic symptoms of patients with primary hyperparathyroidism. We found that psychologic symptom distress is multidimensional, that symptoms had profoundly improved by 1 month after parathyroidectomy, and that somatization and anxiety did not differ between our groups.