Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, UK.
Clin Endocrinol (Oxf). 2012 Feb;76(2):196-200. doi: 10.1111/j.1365-2265.2011.04197.x.
With increased biochemical screening, primary hyperparathyroidism (pHPT) is often discovered incidentally whilst patients are asymptomatic.
To assess the impact of parathyroidectomy on neuropsychological symptoms and biochemical parameters in people with asymptomatic pHPT, whilst controlling for the surgical procedure. PATIENTS/DESIGN/MEASUREMENTS: Twenty-four patients with asymptomatic pHPT requiring parathyroidectomy, in accordance with National Institutes for Health recommendations, were recruited prospectively. A control group of 23 subjects was recruited simultaneously from consecutive patients undergoing diagnostic hemithyroidectomy (HT) for benign thyroid nodules. Operations were performed by a single surgeon. Biochemical investigations and neuropsychological symptoms were measured preoperatively and 3 months after surgery. Neuropsychological symptoms were measured using the Hospital Anxiety (HAD-A) and Depression (HAD-D) scales and the Mood Rating Scale (MRS).
Postoperatively, calcium and parathyroid hormone normalized in all patients in the pHPT group. Patients with pHPT showed a significant improvement in neuropsychological symptoms with a pre- and postoperative mean change of 2·45 ± 2·57 (P < 0·05) on HAD-A, 2·79 ± 3·85 (P < 0·05) on HAD-D, and 3·2 ± 4·57 (P < 0·05) on MRS, parameters that were unaltered in the HT group. The differences between the two groups remained statistically significant after adjustment for age and sex for HAD-D (mean change 2·8, 95% CI = 0·3, 5·3, P = 0·025) and MRS (mean difference 3·5, 95% CI = 0·4, 6·7, P = 0·027) but not for HAD-A (mean difference 1·5, 95% CI = -0·8, 3·8, P = 0·20). For all three mental health scores, there were no significant associations with either age or sex.
Asymptomatic pHPT is associated with neuropsychological symptoms that improve after parathyroidectomy.
随着生化筛查的增加，原发性甲状旁腺功能亢进症（pHPT）常在无症状患者中偶然发现。
评估甲状旁腺切除术对无症状 pHPT 患者神经心理症状和生化参数的影响，同时控制手术过程。
患者/设计/测量：按照美国国立卫生研究院的建议，前瞻性招募了 24 例需要甲状旁腺切除术的无症状 pHPT 患者。同时，从连续接受单侧甲状腺切除术（HT）治疗良性甲状腺结节的患者中招募了 23 名对照组。手术由同一位外科医生进行。术前和术后 3 个月测量生化检查和神经心理症状。神经心理症状使用医院焦虑量表（HAD-A）和抑郁量表（HAD-D）和情绪评定量表（MRS）进行测量。
术后所有 pHPT 组患者的钙和甲状旁腺激素均恢复正常。pHPT 患者的神经心理症状明显改善，HAD-A 术前和术后平均变化为 2.45 ± 2.57（P < 0.05），HAD-D 为 2.79 ± 3.85（P < 0.05），MRS 为 3.2 ± 4.57（P < 0.05），HT 组参数无变化。调整年龄和性别后，两组间 HAD-D（平均变化 2.8，95%CI = 0.3，5.3，P = 0.025）和 MRS（平均差值 3.5，95%CI = 0.4，6.7，P = 0.027）差异仍有统计学意义，但 HAD-A 无差异（平均差值 1.5，95%CI = -0.8，3.8，P = 0.20）。对于所有三种心理健康评分，均与年龄或性别无显著相关性。
无症状 pHPT 与神经心理症状相关，甲状旁腺切除术后症状改善。
