The effect of parathyroidectomy on patients' symptoms in tertiary hyperparathyroidism

BACKGROUND: The efficacy of parathyroidectomy for primary and secondary hyperparathyroidism is well-established but evidence in tertiary hyperparathyroidism is lacking. We examined parathyroidectomy's effect in tertiary hyperparathyroidism. METHODS: Patients with tertiary hyperparathyroidism who underwent parathyroidectomy were followed up for 12 months. A modification of the 13-item parathyroid symptoms list developed by Pasieka was administered at 0, 1, 3, 6, and 12 months post-surgery. We also examined if preoperative factors would predict symptom improvement post-surgery. RESULTS: Ninety-one patients were included. Survey response rates at 1, 3, 6, and 12 months post-surgery were 97.8%, 90.1%, 82.4%, and 80.2%, respectively. Mean preoperative Pasieka parathyroid score (PSS) was 6.3 ± 2.7. At first month, PSS decreased to 2.9 ± 2.0 (P < .001) and was sustained at 3, 6, and 12 months (2.7 ± 2.1, P < .001, 2.3 ± 1.6, P < .001 and 3.4 ± 2.5, P < .001). The degree of PSS reduction at 1-month post-parathyroidectomy correlated strongly with preoperative symptom severity (Pearson's coefficient: 0.690, P < .001). CONCLUSIONS: Parathyroid symptoms unequivocally improve post-parathyroidectomy. The greatest degree of improvement was observed in early postoperative period up to 6 months.