Boston Thyroid, Parathyroid and General Surgeon
This graph compares the fracture rate in patients who had parathyroidectomy compared with those who did not. Parathyroid surgery reduced the risk of fracture. The 10-year fracture-free survival was 73% in those who underwent parathyroidectomy compared with 59% in those who did not.
VanderWalde Arch Surg 2006
This study shows that bone density improves after parathyroid surgery, which is one of the main reasons to recommend surgery. The improvement is over a few years.
Silverberg et al. NEJM 1991
This is a real problem for the elderly. Many elderly patients have hyperparathyroidism with exactly the same symptoms as younger patients. The graph shows patients younger and older than 80 years. However many older patients are not referred for surgery and yet they can benefit immensely.
As many as 30% of patients only realize they had symptoms such as fatigue and muscle aches once they have had surgery.
This is a very important slide because it may explain why some patients are not referred for surgery. It shows that a patient can have equally bad symptoms if their blood level changes are mild or severe. Some physicians do not refer patients because they appear to only have mild elevations of blood calcium.
I see patients who have troublesome symptoms with mild disease, particularly fatigue, and some patients with marked blood calcium elevation who appear to have no symptoms.
Adapted from Eigelberger 2004
This chart shows the wide variety of symptoms that patients with hyperparathyroidism may have. The red bars show patients and the green are comparisons with healthy patients. This is a common way of reporting result in scientific journals.
An elevated blood calcium is detected frequently because of routine blood testing. However even when the blood calcium is elevated many patients are not investigated to exclude hyperparathyroidism and the diagnosis may be delayed for years.
A recent report from the Cleveland Clinic showed that only about 1% of patients with hyperparathyroidism were properly diagnosed and only 0.3% of those diagnosed were treated by surgery, despite many of these patients having the criteria for surgical treatment.
There are guidelines for recommending surgery in hyperparathyroidism and they include any patient with symptoms ( see later slide), and patients without apparent symptoms if: