Neuropsychologic changes in primary hyperparathyroidism after parathyroidectomy from a dual-institution prospective study

The impact of parathyroidectomy on neuropsychiatric symptoms in primary hyperparathyroidism remains poorly defined. The validated scales Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 can be used to assess depression and anxiety, respectively. Our aim was to prospectively characte...

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Bibliographic Details
Published in:Surgery 2021-01, Vol.169 (1), p.114-119
Main Authors: Liu, Jessica Y., Peine, Brandon S., Mlaver, Eli, Patel, Snehal G., Weber, Collin J., Saunders, Neil D., Pofahl, Walter E., Sharma, Jyotirmay
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Anxiety - diagnosis
Anxiety - epidemiology
Anxiety - etiology
Anxiety - psychology
Case-Control Studies
Depression - diagnosis
Depression - epidemiology
Depression - etiology
Depression - psychology
Female
Humans
Hyperparathyroidism, Primary - complications
Hyperparathyroidism, Primary - psychology
Hyperparathyroidism, Primary - surgery
Male
Middle Aged
Parathyroidectomy
Patient Health Questionnaire - statistics & numerical data
Postoperative Period
Preoperative Period
Prevalence
Prospective Studies
Severity of Illness Index
Thyroid Diseases - complications
Thyroid Diseases - psychology
Thyroid Diseases - surgery
Thyroidectomy
Treatment Outcome
Young Adult
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Summary:The impact of parathyroidectomy on neuropsychiatric symptoms in primary hyperparathyroidism remains poorly defined. The validated scales Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 can be used to assess depression and anxiety, respectively. Our aim was to prospectively characterize the changes in neuropsychiatric symptoms after parathyroidectomy. Patients undergoing parathyroidectomy and thyroidectomy (control) from two institutions between 2014 and 2019 were prospectively administered a questionnaire assessing neuropsychiatric symptoms before and after surgery. Paired t tests compared preoperative with postoperative neuropsychiatric symptoms and t tests compared differences in neuropsychiatric symptoms between parathyroidectomy and thyroidectomy. A total of 244 patients underwent parathyroidectomy and 161 underwent thyroidectomy. We observed improvement in neuropsychiatric symptoms after parathyroidectomy (6.2 [5.0–7.4], P < .01). Preoperatively, neuropsychiatric symptoms were more prevalent in patients undergoing parathyroidectomy when compared with thyroidectomy (11.2 ± 11.5 vs 7.5 ± 8.2, P < .01); however, after surgery there was no difference between the two groups (5.1 ± 7.1 vs 5.4 ± 7.2, P = .59). Preoperatively, 27.5% and 18.0% of patients endorsed moderate to severe depression and anxiety, which fell to 8.2% and 5.3%, respectively, (P < .01) after surgery. Patients undergoing parathyroidectomy showed significant improvement in neuropsychiatric symptoms after surgery. Neuropsychiatric symptoms are more prevalent in patients with primary hyperparathyroidism. Neuropsychiatric symptoms should be assessed in all patients with primary hyperparathyroidism and should be considered a relative indication for parathyroidectomy.
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2020.06.006