Medication discontinuation after curative surgery for sporadic primary hyperparathyroidism.

Abstract

Although parathyroidectomy (Ptx) for sporadic primary hyperparathyroidism (PH) improves comorbidities and symptoms, routine Ptx for minimally symptomatic PH remains controversial. Whether successful Ptx translates into discontinuation or dose-reduction of prescribed medications is unknown. Consecutive patients undergoing curative Ptx for sporadic PH from January 2007 to April 2009 were compared to patients undergoing thyroidectomy (Tx). We reviewed patient demographics, symptoms, comorbid conditions, and pre- and postoperative medications utilizing the Fisher exact test and t test for comparisons. Compared to 176 Tx patients, 260 Ptx patients were older (P < .001), more commonly men (P = .006), and had higher preoperative prevalences of every examined PH symptom and comorbid condition. Postoperatively, even minimal PH symptoms improved after Ptx. The mean number of preoperative medications was higher in Ptx patients (4 vs 2.8, P < .001). Discontinuation or dose-reduction of medication occurred in 28 (11%) Ptx patients vs 7 (4%) Tx patients (P = .01). After Ptx, symptom improvement was the predominant reason for beneficial medication changes, and the most common beneficial effect was discontinuation or dose-reduction of chronic analgesics (33%). PH symptoms are numerous and improve after curative Ptx. Medication use for related symptoms can be beneficially reduced by surgery. Drug profiles should be routinely reviewed and adjusted after parathyroidectomy.