Clinical question: Does parathyroidectomy improve mortality or morbidity in mild primary hyperparathyroidism?
Background: It is known that in patients with severe hypercalcemia or symptoms from hyperparathyroidism, parathyroidectomy is beneficial as a curative treatment. However, it is not known whether parathyroidectomy improves mortality or morbidity in patients with mild primary hyperparathyroidism.
Study design: Prospective, randomized, controlled trial
Setting: Eight referral centers in Sweden, Norway, and Denmark
Synopsis: 191 patients (165 women, 26 men) from three Scandinavian countries with mild primary hyperparathyroidism with albumin-corrected calcium levels between 2.6 and 2.8 mmol/L were randomly assigned to observation-only versus parathyroidectomy. They were followed for 10 years, with no significant differences between the groups in mortality, prespecified morbidities, bone mineral density, or quality of life. The prespecified morbidities were cardiovascular disease, cerebrovascular disease, cancer, fractures, kidney stones, and kidney failure. Therefore, it could be concluded that it is safe to observe patients with mild primary hyperparathyroidism for up to 10 years with regard to mortality and the morbidities listed above.
Previous studies have demonstrated a benefit from parathyroidectomy in patients with severe or symptomatic hypercalcemia, but it has not yet been demonstrated whether there is a benefit from parathyroidectomy in patients with mild primary hyperparathyroidism. One limitation of this study is the disproportionate percentage of women versus men enrolled, thereby limiting the external validity of the results to certain patients.
Bottom line: Parathyroidectomy in mild primary hyperparathyroidism does not reduce mortality or morbidity compared to observation alone.
Citation: Pretorius M, et al. Mortality and morbidity in mild primary hyperparathyroidism: results from a 10-year prospective randomized controlled trial of parathyroidectomy versus observation. Ann Intern Med. 2022; 175(6):812-9.
Dr. Morvant is an assistant professor of medicine at the University of Virginia School of Medicine, Charlottesville, Va.