Surgical intervention for primary hyperparathyroidism is associated with a reduction in new-onset neuropsychiatric disorders.

Abstract

Primary hyperparathyroidism has been linked to an increased prevalence of neuropsychiatric disorders. However, there is sparse literature to determine if parathyroidectomy improves the development of new-onset conditions when compared to nonoperative management. This project aims to assess the impact of parathyroidectomy on new-onset neuropsychiatric disorders. Using data from a multi-institutional database, a retrospective cohort was conducted on patients classified with an International Classification of Diseases, Tenth Revision, of primary hyperparathyroidism (E21.0) aged 18 years or older with at least 3 years of follow-up after diagnosis. The study compared those with a previous parathyroidectomy (Current Procedural Terminology code 60500) to those with nonsurgical management. A regression analysis was conducted to compare cohorts and calculate the hazard ratio of developing neuropsychiatric disorders based on International Classification of Diseases, Tenth Revision, codes. The initial query identified 51,983 patients with primary hyperparathyroidism. After matching, 37,194 patients were included and were predominantly White (73.4%, n = 27,324) and female (74.1%, n = 27,582). The parathyroidectomy and nonsurgical groups both contained 18,597 patients, with an average age of 60 ± 13 years. Patients who underwent parathyroidectomy had significantly lower rates of anxiety (hazard ratio 0.72, 95% confidence interval 0.67-0.78), depression (0.76, 0.70-0.84), mania or bipolar disorder (0.45, 0.30-0.67), and mild cognitive decline (0.73, 0.58-0.91) than their nonsurgical counterparts. There was no difference between the groups regarding new-onset schizophrenia (hazard ratio 0.81, 95% confidence interval 0.37-1.80), somnolence (0.87, 0.74-1.02), and suicidal ideation (0.65, 0.41-1.02). Parathyroidectomy was associated with significantly lower rates of new-onset neuropsychiatric disorders in patients with primary hyperparathyroidism compared with medical management.