Mohan Bharth, Abuji Kishore, Dahiya Divya, Tandup Cherring, Bhadada Sanjay, Behera Arunanshu
Department of General Surgery, Post Graduate İnstitute of Medical Education and Research, Chandigarh, India.
Department of Endocrinology, Post Graduate İnstitute of Medical Education and Research, Chandigarh, India.
Turk J Surg. 2021 Sep 28;37(3):247-252. doi: 10.47717/turkjsurg.2021.5156. eCollection 2021 Sep.
Primary hyperparathyroidism (PHPT) is a systemic disease which, along with bone and stone disease, also causes several subjective symptoms which impairs the quality of life (QoL). However, NIH guidelines do not include non-specific physical and neuropsychological symptoms as an indication of parathyroidectomy. SF-36 is one of the most commonly used tools for assessing QoL; it measures both physical health (PH) and mental health (MH).
This is a prospective observational study including 50 patients of symptomatic PHPT. Patients were categorized into normocalcemia (8.5-10.4 mg/dL), mild hypercalcemia (10.5-11.9 mg/dL), moderate hypercalcemia (12-13.9 mg/dL), and severe hypercalcemia (>14 mg/dL). QoL was assessed by using SF36 survey both pre-operative and three months after parathyroidectomy.
There was an overall improvement in QoL of individual groups both in PH and MH components (p <0.001). The improvement was more substantial for bodily pain, role physical, vitality and mental health. Although QoL was affected in patients with mild hypercalcemia, it was more affected in patients with severe hypercalcemia. The improvement in MH scores was dependent on the level of pre-operative calcium; however, the improvement in PH scores was independent of pre-operative calcium (p= 0.698).
This study showed improvement in all aspects of PH and MH of SF-36 after parathyroidectomy, even in normocalcemics. Despite the fact that current guidelines for the management of PHPT do not include QoL as an indication for parathyroidectomy, we propose that parathyroidectomy should be considered, if patient is fit for surgery.
原发性甲状旁腺功能亢进症（PHPT）是一种全身性疾病，除了导致骨病和结石病外，还会引起多种主观症状，影响生活质量（QoL）。然而，美国国立卫生研究院（NIH）的指南并未将非特异性身体和神经心理症状列为甲状旁腺切除术的指征。SF-36是评估生活质量最常用的工具之一；它同时测量身体健康（PH）和心理健康（MH）。
这是一项前瞻性观察性研究，纳入了50例有症状的PHPT患者。患者被分为血钙正常（8.5 - 10.4mg/dL）、轻度高钙血症（10.5 - 11.9mg/dL）、中度高钙血症（12 - 13.9mg/dL）和重度高钙血症（>14mg/dL）。在甲状旁腺切除术前和术后三个月使用SF36调查问卷评估生活质量。
各个组在身体健康和心理健康方面的生活质量均有总体改善（p<0.001）。身体疼痛、身体功能、活力和心理健康方面的改善更为显著。虽然轻度高钙血症患者的生活质量受到影响，但重度高钙血症患者受到的影响更大。心理健康评分的改善取决于术前血钙水平；然而，身体健康评分的改善与术前血钙水平无关（p = 0.698）。
本研究表明，甲状旁腺切除术后SF-36的身体健康和心理健康的各个方面均有改善，即使是血钙正常的患者。尽管目前PHPT的管理指南未将生活质量列为甲状旁腺切除术的指征，但我们建议，如果患者适合手术，应考虑进行甲状旁腺切除术。
