Parathyroidectomy is safe and improves symptoms in elderly patients with primary hyperparathyroidism (PHPT).
OBJECTIVE
Parathyroidectomy for primary hyperparathyroidism (PHPT) is curative in over 95% of cases. Although PHPT affects up to 2% of the elderly population, whose life expectancy may be a decade or more, such patients may be denied surgery because of perceived risk. This study investigates the outcomes of surgery for PHPT in the elderly.


METHODS
Consecutive patients with PHPT treated at a tertiary referral centre over 5 years.


METHODS
A prospective database recorded clinical, biochemical and pathological information. Pasieka's parathyroid symptom scores were obtained pre-operatively and post-operatively, from a recent subgroup of 70 consecutive patients. Deaths during follow-up were identified using the NHS Strategic Tracing Service. Statistical analysis was performed with spss v12.0.


RESULTS
Between November 2002 and October 2007, 224 patients (17-89 years) underwent surgery for PHPT. In the subgroup comprising patients aged >75 years there was a significantly greater proportion of women (47/56 vs. 52/81, P < 0.05). Pre-operative indices of these patients were similar to younger patients, as were proportions undergoing minimally invasive parathyroidectomy (n = 134) or bilateral neck exploration (n = 90). Patients >75 years had a longer hospital stay (1.6 vs. 0.8 days, P = 0.003). Pasieka's symptom scores improved significantly at 3-6 months postoperatively in all age groups. During a minimum median follow-up of 22 months, there were seven patients with persistent/recurrent disease. Median 2-year survival of those aged 60-74 and those over 75 ranged from 85-90%.


CONCLUSIONS
Parathyroidectomy is safe in the elderly and is associated with a significant improvement in symptoms. As survival after operation is similar to younger patients, surgery should be considered in all elderly patients with PHPT.
Stechman
Michael J
MJ
Department of Endocrine Surgery, John Radcliffe Hospital, Oxford, UK. mstechman@doctors.org.uk
Weisters
Mary
M
Gleeson
Fergus V
FV
Sadler
Gregory P
GP
Mihai
Radu
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult