title: Health-related quality of life is impaired in primary hyperparathyroidism and significantly improves after surgery: a prospective study using the 15D instrument.
abstract: Health-related quality of life (HRQoL) is frequently impaired in primary hyperparathyroidism (PHPT) but it is unclear if surgery is beneficial. The objective was to prospectively assess HRQoL in PHPT (n=124) with the 15D instrument before and after surgery, to compare it with that of a comparable sample of the general population (n=4295), and search for predictors of HRQoL and its change. HRQoL, and clinical and laboratory parameters were measured before and at 6 and 12 months after surgery. Regression techniques were used to search for predictors of HRQoL and gains from treatment. Before surgery, PHPT patients had significantly lower mean 15D score compared to controls (0.813 vs 0.904, P<0.001). Excretion, mental function, discomfort and symptoms, distress, depression, vitality, and sexual activity were most impaired (all P<0.001). Number of medications (P=0.001) and subjective symptoms (P<0.05) but not calcium or parathyroid hormone (PTH) predicted impaired HRQoL. Serum 25-hydroxyvitamin D (25OHD) was of borderline significance (P=0.051). Compared to baseline, mean 15D score improved significantly 6 months after surgery (0.813 vs 0.865, P<0.001) and the effect sustained at 1 year (0.878, P<0.001). The improvement was clinically important in 77.4% of patients (P<0.001). Educational level independently predicted improvement (P<0.005). HRQoL is severely impaired in PHPT but improves significantly after surgery. The 15D is a sensitive tool for assessing HRQoL and recognizing patients likely to benefit from surgery.
authors.affiliation: EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Post Box 340, FI-00290 Helsinki, FinlandDepartment of Public HealthUniversity of Helsinki, Helsinki, FinlandGroup AdministrationResearch and Development, University of Helsinki, Helsinki, FinlandHelsinki University HospitalHelsinki, FinlandUniversity of Eastern FinlandKuopio, Finland.
authors.forename: Eeva M
authors.initials: EM
authors.lastname: Ryhänen
authors.affiliation: EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Post Box 340, FI-00290 Helsinki, FinlandDepartment of Public HealthUniversity of Helsinki, Helsinki, FinlandGroup AdministrationResearch and Development, University of Helsinki, Helsinki, FinlandHelsinki University HospitalHelsinki, FinlandUniversity of Eastern FinlandKuopio, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Heiskanen
authors.affiliation: EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Post Box 340, FI-00290 Helsinki, FinlandDepartment of Public HealthUniversity of Helsinki, Helsinki, FinlandGroup AdministrationResearch and Development, University of Helsinki, Helsinki, FinlandHelsinki University HospitalHelsinki, FinlandUniversity of Eastern FinlandKuopio, Finland.
authors.forename: Harri
authors.initials: H
authors.lastname: Sintonen
authors.affiliation: EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Post Box 340, FI-00290 Helsinki, FinlandDepartment of Public HealthUniversity of Helsinki, Helsinki, FinlandGroup AdministrationResearch and Development, University of Helsinki, Helsinki, FinlandHelsinki University HospitalHelsinki, FinlandUniversity of Eastern FinlandKuopio, Finland.
authors.forename: Matti J
authors.initials: MJ
authors.lastname: Välimäki
authors.affiliation: EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Post Box 340, FI-00290 Helsinki, FinlandDepartment of Public HealthUniversity of Helsinki, Helsinki, FinlandGroup AdministrationResearch and Development, University of Helsinki, Helsinki, FinlandHelsinki University HospitalHelsinki, FinlandUniversity of Eastern FinlandKuopio, Finland EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Post Box 340, FI-00290 Helsinki, FinlandDepartment of Public HealthUniversity of Helsinki, Helsinki, FinlandGroup AdministrationResearch and Development, University of Helsinki, Helsinki, FinlandHelsinki University HospitalHelsinki, FinlandUniversity of Eastern FinlandKuopio, Finland EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Post Box 340, FI-00290 Helsinki, FinlandDepartment of Public HealthUniversity of Helsinki, Helsinki, FinlandGroup AdministrationResearch and Development, University of Helsinki, Helsinki, FinlandHelsinki University HospitalHelsinki, FinlandUniversity of Eastern FinlandKuopio, Finland.
authors.forename: Risto P
authors.initials: RP
authors.lastname: Roine
authors.affiliation: EndocrinologyAbdominal Center, University of Helsinki and Helsinki University Hospital, Post Box 340, FI-00290 Helsinki, FinlandDepartment of Public HealthUniversity of Helsinki, Helsinki, FinlandGroup AdministrationResearch and Development, University of Helsinki, Helsinki, FinlandHelsinki University HospitalHelsinki, FinlandUniversity of Eastern FinlandKuopio, Finland camilla.schalin-jantti@hus.fi.
authors.forename: Camilla
authors.initials: C
authors.lastname: Schalin-Jäntti
keywords: 15D; health-related quality of life; primary hyperparathyroidism; surgery