Impact of parathyroidectomy on quality of life in multiple endocrine neoplasia type 1

Abstract

Background: Potential influences of parathyroidectomy (PTx) on the quality of life (QoL) in multiple endocrine neoplasia type 1-related primary hyperparathyroidism (HPT/MEN1) are unknown.

Method: Short Form 36 Health Survey Questionnaire was prospectively applied to 30 HPT/MEN1 patients submitted to PTx (20, subtotal; 10, total with autograft) before, 6 and 12 months after surgery. Parameters that were analyzed included QoL, age, HPT-related symptoms, general pain, comorbidities, biochemical/hormonal response, PTx type and parathyroid volume.

Results: Asymptomatic patients were younger (30 vs 38 years; P = 0.04) and presented higher QoL scores than symptomatic ones: Physical Component Summary score (PCS) 92.5 vs 61.2, P = 0.0051; Mental Component Summary score (MCS) 82.0 vs 56.0, P = 0.04. In both groups, QoL remained stable 1 year after PTx, independently of the number of comorbidities. Preoperative general pain was negatively correlated with PCS (r = -0.60, P = 0.0004) and MCS (r = -0.57, P = 0.0009). Also, moderate/intense pain was progressively (6/12 months) more frequent in cases developing hypoparathyroidism. The PTx type and hypoparathyroidism did not affect the QoL at 12 months although remnant parathyroid tissue volume did have a positive correlation (P = 0.0490; r = 0.3625) to PCS 12 months after surgery. Patients with one to two comorbidities had as pre-PTx PCS (P = 0.0015) as 12 months and post-PTx PCS (P = 0.0031) and MCS (P = 0.0365) better than patients with three to four comorbidities.

Conclusion: A variable QoL profile was underscored in HPT/MEN1 reflecting multiple factors associated with this complex disorder as comorbidities, advanced age at PTx and presence of preoperative symptoms or of general pain perception. Our data encourage the early indication of PTx in HPT/MEN1 by providing known metabolic benefits to target organs and avoiding potential negative impact on QoL.

Keywords: hyperparathyroidism; hypoparathyroidism; multiple endocrine neoplasia type 1; parathyroidectomy; quality of life.

Figure 1

Flow diagram of included patients. *(n  = 1) neck re-operation by persistence of HPT. AG, autograft; HPT/MEN1, multiple endocrine neoplasia type 1-related primary hyperparathyroidism; SPTx, subtotal parathyroidectomy; SF-36, Short Form 36 Health Survey Questionnaire; TPTx+AG, total parathyroidectomy with autograft.

Figure 2

PCS and MCS before and after the operation according to preoperative symptoms. mo, months; PCS, Physical Component Summary score, pre, preoperative; MCS, Mental Component Summary score.

Figure 3

Postoperative changes in the median quality of life scores (PCS and MCS) according to definitive HYPO after the operation. HYPO, hypoparathyroidism; PCS, Physical Component Summary score, pre, preoperative; mo, months; MCS, Mental Component Summary score.