Parathyroidectomy is safe and improves symptoms in elderly patients with primary hyperparathyroidism (PHPT)

Published on Dec 1, 2009in Clinical Endocrinology3.38
· DOI :10.1111/J.1365-2265.2009.03540.X
Michael J. Stechman2
Estimated H-index: 2
(John Radcliffe Hospital),
Mary Weisters2
Estimated H-index: 2
(John Radcliffe Hospital)
+ 2 AuthorsRadu Mihai27
Estimated H-index: 27
(John Radcliffe Hospital)
Sources
Abstract
Summary Objective  Parathyroidectomy for primary hyperparathyroidism (PHPT) is curative in over 95% of cases. Although PHPT affects up to 2% of the elderly population, whose life expectancy may be a decade or more, such patients may be denied surgery because of perceived risk. This study investigates the outcomes of surgery for PHPT in the elderly. Design and patients  Consecutive patients with PHPT treated at a tertiary referral centre over 5 years. Measurements  A prospective database recorded clinical, biochemical and pathological information. Pasieka’s parathyroid symptom scores were obtained pre-operatively and post-operatively, from a recent subgroup of 70 consecutive patients. Deaths during follow-up were identified using the NHS Strategic Tracing Service. Statistical analysis was performed with spss v12.0. Results  Between November 2002 and October 2007, 224 patients (17–89 years) underwent surgery for PHPT. In the subgroup comprising patients aged >75 years there was a significantly greater proportion of women (47/56 vs. 52/81, P  75 years had a longer hospital stay (1·6 vs. 0·8 days, P = 0·003). Pasieka’s symptom scores improved significantly at 3–6 months postoperatively in all age groups. During a minimum median follow-up of 22 months, there were seven patients with persistent/recurrent disease. Median 2-year survival of those aged 60–74 and those over 75 ranged from 85–90%. Conclusion  Parathyroidectomy is safe in the elderly and is associated with a significant improvement in symptoms. As survival after operation is similar to younger patients, surgery should be considered in all elderly patients with PHPT.
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