ABSTRACT
BACKGROUND: Surgery is the definitive treatment of secondary hyperparathyroidism (2HPT) and end stage renal disease patients. The aim of this study to assess the impact of surgery on the evolution of quality of life (QoL) in patients with 2HPT, and to identify the variables that influence this evolution. METHODS: A series of 85 consecutive unselected patients underwent total parathyroidectomy for 2HPT in our clinic. QoL was measured using the Short-Form Health Survey(SF-36) and alleviation of symptoms was documented using an outcome tool (PAS score), based on visual analog scales, preoperatively, postoperatively and at 6 months. RESULTS: Preoperatively, patients had lower SF-36 scores than the general population in all 8 individual and 2 component summary scales, with significant decrease in the physical health scales(p 0.0001). Patients improved in all ten scales at 6 months follow-up, most significant being: Body Pain (45.02+-5.52 vs 33.12+-8.82, p 0.0001), Role-physical (41.00+-7.43 vs 33.46+-8.54, p 0.0001), Physical functioning (40.06 +-7.77 vs 33.36 +-10.84, p 0.0001). PAS Scores decreased from preoperatory levels of 569.99 +- 136.45 to 372.20 +- 104.62 at 7 days after surgery and furthermore at 292.64 +- 85.16 at 6 months follow-up (p 0.0001). CONCLUSIONS: We found no correlation between preoparatory PTH or Calcium levels and clinical symptoms. Parathyroidectomy clearly alleviates symptomatology and improves QoL in 2HPT patients, with durable effect at 6 months.
Subject(s)
Hyperparathyroidism, Secondary/surgery , Kidney Failure, Chronic/complications , Parathyroidectomy , Quality of Life , Adult , Female , Follow-Up Studies , Humans , Hyperparathyroidism, Secondary/complications , Male , Mathematical Computing , Middle Aged , Postoperative Period , Prospective Studies , Surveys and Questionnaires , Treatment OutcomeABSTRACT
BACKGROUND: Secondary hyperparathyroidism (SHPT), develops, more or less in all the patients with chronic kidney disease. The pathology is even more severe as it intervenes in a suffering patient in whom the chronic kidney disease frequently associates severe comorbidities. General mortality is higher than in general population. The failure of the medical therapy is an indication for parathyroidectomy. METHODS: The study analyzed 200 patients with SHPT and chronic kidney disease, admitted in the clinic from October 2011 until January 2015.In this period, 179 (89.5 %) total-parathyroidectomies have been performed a long with 14 (7%) subtotal parathyroidectomies. Also 7 (3.5%) surgical interventions were incomplete. RESULTS: Overall mortality was 1% (2 patients) and postoperative specific morbidity 3.5% -4 local hemorrhagic complications and 3 cases of dysphonia have been encountered (12% if we include the reinterventions for recurrent hyperparathyroidism - 17 patients). CONCLUSIONS: Total parathyroidectomy is encumbered by a reduced number of postoperative complications and the risk of recurrent disease in almost nonexistent. The disadvantages of this surgical approach are the tendency of immediate postoperative hypocalcemia and long therm substitution with calcium and vitamine D.
