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A Plea for Early Surgical Referral

Electron Kebebew, MD; Quan-Yang Duh, MD; Orlo H. Clark, MD

Arch Surg. 2003;138:867-871.

Background  Surgical referral of elderly patients with PHPT is often deferred because of the perceived risks of general anesthesia, increased age, and comorbidities and also because many of the symptoms of PHPT are difficult to distinguish from the aging process.

Hypothesis  Parathyroidectomy for primary hyperparathyroidism (PHPT) in elderly patients is beneficial and safe.

Design  Retrospective study of patients with PHPT who were 80 years and older.

Setting  Tertiary academic referral medical center.

Patients  Fifty-four consecutive patients (43 women and 11 men) with a mean age of 83.6 years who underwent parathyroidectomy for PHPT.

Main Outcome Measures  Delay in surgical referral; improvement in symptoms and normalization of serum calcium and parathyroid hormone levels; and perioperative morbidity and mortality.

Results  Twelve (22%) of 54 patients had a mean delay of 5 years (range, 1.2-10.0 years) before surgical referral for a known diagnosis of PHPT. No patient had asymptomatic PHPT. There was no significant difference in the preoperative mean serum calcium level and symptoms of PHPT resulting from delay in surgical referral. Parathyroidectomy resulted in significant improvement of PHPT-associated symptoms of fatigue, weight loss, nocturia, bone pain, constipation, and major depression (P<.05). All patients had normal serum calcium and parathyroid hormone levels postoperatively. The average length of hospitalization was 1.9 days. There were 3 complications (9%): 1 urinary tract infection, 1 bladder perforation, and 3 transient hypocalcemia. There was no perioperative mortality.

Conclusions  Parathyroidectomy in elderly patients is safe, curative, and beneficial. Surgical referral for parathyroidectomy should be considered in elderly patients with PHPT.

From the Department of Surgery, University of California, San Francisco.

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