Parathyroidectomy does not lessen morbidity, mortality in mild hyperparathyroidism

Parathyroidectomy (PTX) seems ineffective at reducing morbidity or mortality in patients with mild primary hyperparathyroidism (PHPT) relative to observation without intervention, suggests a study. For at least a decade, observation has seen no evidence of adverse effects regarding mortality, fractures, cancer, cardiovascular (CV) and cerebrovascular (CBV) events, or renal morbidities.

From 1998 to 2005, 191 patients with mild PHPT participated in this prospective randomized controlled trial in eight Scandinavian referral centres. Of these, 95 were randomized to PTX and 96 to observation without intervention (OBS).

Fifteen patients had died (eight in the PTX group and seven in the OBS group) after 10 years. Within the extended observation period, 44 deaths occurred, with an even between-group distribution (24 in the PTX group and 20 in the OBS group).

Some 101 morbidity events (ie, CV and CBV events, cancer, peripheral fractures, and renal stones) were also evenly distributed between the PTX and OBS groups (52 vs 49, respectively). A total of 16 vertebral fractures occurred in 14 patients (seven in each group) during the study.

The study was limited by the withdrawal of 23 patients in the PTX group and 27 in the OBS group.

“PHPT is a common endocrine disorder associated with increased risk for fractures, CV disease, kidney disease, and cancer and increased mortality,” the investigators said.