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Edited by Yimaitong, please do not reprint without permission
.
Although parathyroidectomy is recommended for patients with hyperparathyroidism with severe hypercalcemia or overt symptoms, the long-term benefit of surgery in mild hyperparathyroidism has been debated
.
Recently, the results of a randomized prospective study published in the journal Annals of internal medicine (25.
391) showed that in patients with mild primary hyperparathyroidism, surgical resection was associated with greater than 10-year survival or survival compared with non-surgical treatment.
There was no benefit in terms of disease incidence, including fractures, cancer, or cardiovascular outcomes
.
"Compared with previous data showing 'increased mortality and cardiovascular morbidity in patients with mild primary hyperparathyroidism', we did not find any therapeutic effect of parathyroidectomy on these important clinical endpoints," the investigators said.
preach
.
There was no significant difference in mortality between the surgical and nonsurgical groups.
A total of 191 patients aged 50-80 years with mild primary hyperparathyroidism were recruited between 1998 and 2005 in Sweden, Norway, and Denmark ( Serum calcium levels 10.
42-11.
22 mg/dL)
.
Participants were randomized to a surgery group (n=95) and a no-intervention non-surgical observation group (n=96)
.
After 10 years of follow-up, a total of 129 patients completed their last follow-up
.
1.
Mortality The overall mortality rate during the 10-year follow-up was 7.
6% (8 in the surgery group and 7 in the non-surgical group), and there was no significant difference between the two groups (HR, 1.
17; P=0.
76)
.
The observation period was extended to 2018, and the overall mortality rate increased, but the distribution of deaths in the surgery group (24 people) and the non-surgery group (20 people) was also relatively even
.
"Chronic hypercalcemia associated with primary hyperparathyroidism has long been associated with an increased risk of cardiovascular disease or cancer, however, the absolute numbers of these and other disease-specific causes of death were nearly identical across groups, ' the authors wrote
.
2.
A total of 101 incidents including cardiovascular events, cerebrovascular events, cancer, peripheral fractures and kidney stones occurred in the incidence of related diseases, including 52 cases in the operation group and 49 cases in the non-surgery group, and there was also no significant difference
.
A total of 16 vertebral fractures occurred in 14 patients, and there were 7 cases in each group
.
The authors noted, "The incidence of peripheral fractures in women in our study was approximately 2900 per 100,000 person-years, the same rate as in 70-year-old women in a study in Gothenburg, Sweden (about 2600 per 100,000 person-years)
.
" Gender and age issues to be considered, the researchers noted that limitations of the study included the inclusion of only 26 men (13 in each group) and only 16 completed the study
.
Therefore, this study has limited clinical guidance for male patients
.
In addition, the subjects included in this study were all > 50 years old.
Considering that younger patients (age < 50 years) may have more aggressive disease, the results of this study should not be generalized to the younger patient group
.
References: [1] Pretorius M, Lundstam K, Heck A, et al.
Mortality and Morbidity in Mild Primary Hyperparathyroidism: Results From a 10-Year Prospective Randomized Controlled Trial of Parathyroidectomy Versus Observation.
ANNALS OF INTERNAL MEDICINE.
2022 Apr 19.
DOI: 10.
7326/M21-4416, PMID:35436153[2]Bolland MJ, Grey A.
Nonoperative Management of Mild Primary Hyperparathyroidism: A Reasonable, Evidence-Based Option.
ANNALS OF INTERNAL MEDICINE.
2022 Apr 19.
DOI: 10.
7326/M22- 0922, PMID:35436154