title: Do the National Institutes of Health consensus guidelines for parathyroidectomy predict symptom severity and surgical outcome in patients with primary hyperparathyroidism?
abstract: BACKGROUND
  The National Institutes of Health (NIH) consensus guidelines for parathyroidectomy in primary hyperparathyroidism were developed addressing only the classic symptoms and physiologic markers of hyperparathyroidism. The purpose of this study was to assess whether NIH guidelines predict the severity of all symptoms and the outcome of operation.
  
  
  METHODS
  Symptom severity measurements using a disease-specific outcome tool called the parathyroidectomy assessment of symptoms (PAS) scores were previously obtained in patients with hyperparathyroidism. Patients were retrospectively stratified into 2 groups: group A, in which 1 or more of the NIH guidelines were met; and group B. in which operation was performed without any of the NIH criteria. For comparison, group C consisted of patients with non-toxic thyroid disease. PAS scores were collected preoperatively, and at 7 days, 3 months, and 12 months postoperatively.
  
  
  RESULTS
  There were 95 patients in group A, 22 in group B, and 58 in group C. The median preoperative PAS scores for group A (354) and B (301) were not significantly different, however, both were more symptomatic than group C (176, P <.01). After parathyroidectomy, patients in both group A and B had a significant improvement in their PAS scores (A=177 and B=130, P <.05).
  
  
  CONCLUSIONS
  Patients with no NIH criteria for operation are equally symptomatic compared with those who meet the NIH guidelines. Parathyroidectomy significantly improved these symptoms whether or not the patient met the NIH consensus guidelines.
authors.affiliation: Department of Surgery, Divisions of General Surgery and Surgical Oncology, University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada T2N 2T9.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Sywak
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Knowlton
authors.forename: Janice L
authors.initials: JL
authors.lastname: Pasieka
authors.forename: Louise L
authors.initials: LL
authors.lastname: Parsons
authors.forename: Jean
authors.initials: J
authors.lastname: Jones
mesh_terms: D000328:Adult; D015975:Consensus Development Conferences, NIH as Topic; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D016105:Parathyroidectomy / Q000592:standards*; D011183:Postoperative Complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D014481:United States