Endocrine Abstracts

Background Comprehensive evaluation of the effect of surgery in patients with primary hyperparathyroidism (PHPT) and monitoring of patient’s well-being after treatment including assessment of patient-reported outcomes is worthwhile.

AIMWe aimed to assess changes in quality of life (QoL) and symptoms in patients with symptomatic and asymptomatic PHPT after surgery (parathyroidectomy, PTX).

Materials and methods.Adult patients with PHPT who were referred for PTX were included in the single-center prospective observational real-world study. Patients filled out generic and specific questionnaires, namely SF-36 and PHPQoL, for QoL assessment and symptom checklist for assessment of presence and severity of their symptoms prior to surgery and 3, 12 months after PTX. Statistical analysis included Student’s t-test or Wilcoxon’s non-parametric test, the generalized estimating equations (GEE) method, correlation analysis, and χ2 test.

ResultsIn total 72 patients (mean age (S.D.) – 52 years (10.4), 97% female) with symptomatic (68%) and asymptomatic (32%) PHPT were enrolled in the study. Moderate/severe hypercalcemia was observed in 34.7% patients. Before PTX patients with PHPT experienced significantly decreased role functioning, physical and social functioning, and vitality as compared to healthy controls (P<0.05). Mean PHPQoL score was 53.7 (IQR: 42.2–64.1). Half of the patients experienced moderate-to-severe symptoms such as weakness, fatigue, cognitive impairment, changes in mood, as well as joint and bone pain. In 3 and 12 months after surgery, improvement in both physical and psychological components of QoL in PHPT patients was shown. Significant changes were observed for the total PHPQoL score as well as for role, physical, emotional and social functioning and vitality by SF-36 (GEE, P<0.05). Positive QoL changes were demonstrated for patients with both symptomatic and asymptomatic PHPT, but they were more pronounced in the first ones. QoL improvement was not associated with baseline Ca level or type of PHPT (χ², P>0.05), but correlated with baseline QoL: the lower baseline QoL the higher QoL improvement after PTX (r=−0.376, P<0.05). Significant decrease in PHPT-associated symptoms such as weakness, fatigue, loss of concentration and mood changes was found within 12 months after PTX (GEE, P<0.05); it was more pronounced in symptomatic PHPT.

ConclusionPTX leads to pronounced positive QoL changes in PHPT patients. The results obtained demonstrate that QoL improvement is a valuable outcome of surgery both in patients with symptomatic and asymptomatic PHPT. Positive effect of PTX from patient’s perspective confirms the value of QoL assessment to measure the degree of recovery at long term follow-up.