Surgical therapy of primary hyperparathyroidism. Quality of life after 10 years prospective observation

AIM OF THE STUDY: The quality of life after surgery for primary hyperparathyroidism was evaluated in a prospective long-term follow-up study. PATIENTS AND METHODS: Altogether 383 patients, 374 with the first manifestation, 6 with recurrent and 3 with persistent disease, who underwent operation from August 1, 1987 to February 15, 1999 were prospectively investigated and included in a long-term follow-up study. All patients underwent reexaminations at regular surveillance intervals. The postoperative course is known in 93.7% of all patients. We carried out 1,504 follow-up examinations (per patient: 1-12, median 4). The follow-up period ranged from 1 month to 10 years with a median of 24 months (mean 34.5 +/- 29.8 months). RESULTS: The true frequency of asymptomatic primary hyperparathyroidism could be confirmed only postoperatively, because a part of the patients were unaware of mild symptoms of hypercalcaemic syndrome prior to surgery. Therefore the prevalence of asymptomatic primary hyperparathyroidism was 5.6% in our patients. Surgical cure was obtained in 97.6% of patients after initial neck exploration. Successful parathyroidectomy provided long-term relief of symptoms in our patients. In 58% of the patients with hypercalcaemic syndrome recovery occurred within the first month after surgery. Bone and joint pain persisted for a longer period of time and was present in 24% of patients two years after the operation. During the follow-up period the mortality of our study population was significantly higher (p = 0.00024) than the expected mortality risk for the German population as a whole. CONCLUSIONS: The present prospective follow-up study yielded conclusive outcome research data after operative therapy for primary hyperparathyroidism. The high biochemical cure rate with long-term relief of symptoms, as well as the increased mortality after successful parathyroidectomy emphasize the importance of early diagnosis and early surgical treatment for primary hyperparathyroidism, even in the absence of manifest symptoms.