Timing of symptom improvement after parathyroidectomy for primary hyperparathyroidism

Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
Surgery (Impact Factor: 3.38). 12/2013; 154(6):1463-9. DOI: 10.1016/j.surg.2013.09.005
Source: PubMed


The timing of symptom improvement after parathyroidectomy for primary hyperparathyroidism (PHPT) has not been well characterized.
This prospective study involved administering a questionnaire to patients with PHPT who underwent curative parathyroidectomy over an 11-month period. The questionnaire evaluated the frequency of 18 symptoms of PHPT on a 5-point Likert scale and was administered preoperatively and 1 week, 6 weeks, and 6 months postoperatively.
Of 197 eligible patients, 132 (67%) participated in the study. The questionnaires were completed at a rate of 91%, 92%, and 86% at 1 week, 6 weeks, and 6 months postoperatively, respectively. The most commonly reported preoperative symptoms were fatigue (98%), muscle aches (89%), and bone/joint pain (87%). Improvement in symptom severity occurred across all symptoms and was separated into three categories based on the timing of improvement. Fatigue and bone/joint pain demonstrated "Immediate Improvement" (>50% of patients reporting improvement by post-operative week 1), whereas the majority of symptoms showed peak improvement at 6 weeks ("Delayed Improvement"). Symptoms categorized as "Continuous Improvement" were those showing progressive improvement up to 6 months postoperatively (polydipsia, headaches, and nausea/vomiting).
Symptom improvement was most prominent 6 weeks postparathyroidectomy, although some symptoms showed continued improvement at 6 months.

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    ABSTRACT: Curative parathyroidectomy for primary hyperparathyroidism (PHPT) resolves various nonspecific symptoms related to the disease. Between 8% and 40% of patients with normocalcemia after parathyroidectomy have persistently elevated parathyroid hormone (ePTH) levels at follow-up. We investigated whether ePTH in the early postoperative period was associated with the timing of symptom improvement. This prospective study included adult patients with PHPT who underwent curative parathyroidectomy from November 2011 to September 2012. Biochemical testing at 2 wk postoperatively identified ePTH (defined as PTH > 72 pg/mL) versus normal PTH (nPTH). A questionnaire administered pre- and post-operatively at 6 wk and 6 mo asked patients to rate the frequency of 18 symptoms of PHPT on a five-point Likert scale. Student t-tests were used to compare pre- with postoperative changes in scores for individual symptoms. Of 194 patients who underwent parathyroidectomy, 129 (66%) participated in the study. Preoperatively, all patients were symptomatic, with a mean of 13 ± 4 symptoms. Two weeks postoperatively, 20 patients (16%) had ePTH. The percentage of patients with postoperative improvement for individual symptoms was compared between groups. At the early time point (6 wk), the ePTH group showed less improvement in 14 of 18 symptoms. This difference reached statistical significance for four symptoms: anxiety, constipation, thirst, and polyuria. By the 6-mo time point, these differences had resolved, and symptom improvement was similar between groups. ePTH after curative parathyroidectomy may result in a delay in symptom improvement 6 wk postoperatively; however, this difference resolves in 6 mo.
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    ABSTRACT: Introduction: Radioguided parathyroidectomy (RGP) uses technetium-99 m sestamibi causing gamma ray emission during RGP to aid dissection and confirm parathyroid excision. Source (the patient) proximity and exposure duration determine degree of exposure. The purpose of this study was to quantify surgeon and staff radiation exposure during RGP. Methods: Surgeons and assistants wore radiation dosimeters during RGP procedures at a high-volume endocrine surgery practice. Area dosimeters measured personnel potential exposure. Data were prospectively collected. Provider exposures were corrected for both duration of exposure and case volume. Institutional safety requirements uses 100 mrem/year as an indicator for radiation safety training, 500 mrem/year for personal monitoring, and a maximum allowed exposure of 4,500 mrem/year. Results: A total of 120 RGP were performed over 6 months. Badges were worn in 82 cases (68 %). Three faculty and four assistants were included. Primary hyperparathyroidism was the diagnosis for 95 %. Median case volume per provider was 13 cases (range 6-45), with median exposure of 18 h (range 9-70). Mean provider deep dose exposure (DDE) was 22 ± 10 mrem. Corrected for exposure duration, mean DDE was 0.6 ± 0.2 mrem/h. Corrected for case volume, mean DDE was 0.8 ± 0.2 mrem/case. Anesthesia exposure was minimal, while mayo stand exposure was half to two thirds that of the surgeon and assistant. Based on institutional guidelines and above data, 125 RGP/year warrants safety training, 625 RGP/year warrants monitoring, whereas >5,600 RGP/year may result in maximum allowed radiation exposure to the surgeon. Conclusions: Surgeon and staff radiation exposure during RGP is minimal. However, high-volume centers warrant safety training.
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    ABSTRACT: Background Primary hyperparathyroidism (PHPT) is a disease process traditionally thought to present during middle age, but can occur at any age. The purpose of this study was to compare PHPT patient characteristics based on patient age at the time of surgical referral. Methods A retrospective review of a prospectively managed database of adult patients undergoing parathyroid surgery for PHPT was conducted. Patients with a negative family history, no previous parathyroid surgery, and ≥6-mo follow-up were included. Patients were grouped by age for comparison. Results From 2001–2012, 1372 patients met inclusion criteria. Age groups were as follows: ≤50 y, 51–60 y, 61–70 y, and >70 y. Female predominance increased with age (P > 0.01). Baseline serum parathyroid hormone levels were higher at the extremes of age (P < 0.001). Young patients had the highest serum calcium (P < 0.01), urinary calcium (P < 0.001), and T-score (P < 0.001) measures, and greater incidence of vitamin D deficiency (P = 0.03). The use of local anesthesia increased with age, whereas use of outpatient parathyroidectomy decreased with age (both P < 0.01). Rates of disease persistence (2.3%–2.9%, P = 0.95) and recurrence (2.1%–3.3%, P = 0.75) were low, and did not differ. Conclusions Patients at the extremes of age are referred with more elevated laboratory indices whereas those in the traditional age range have milder biochemical indices. This may result from differential surgical referral. Individuals with laboratory evidence of abnormal calcium and parathyroid hormone regulation should be evaluated for parathyroidectomy regardless of age because all ages can be successfully treated.
    No preview · Article · Jul 2014 · Journal of Surgical Research
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