Salutary effect of parathyroidectomy on neuropsychiatric symptoms in patients with primary hyperparathyroidism: Evaluation using PAS and SF-36v2 scoring systems

Abstract

Background : Indian patients with primary hyperparathyroidism (pHPT) usually present with a triad of advanced disease of bones, stones, and psychic moans. There are hardly any reports from India on the outcome of successful parathyroidectomy on psychiatric symptoms. Aims : To evaluate the outcome of parathyroidectomy on psychiatric symptoms in Indian patients with advanced pHPT. Settings and Design : Prospective study done in a tertiary care super-specialty hospital in northern India. Materials and Methods : Health surveys using parathyroid assessment of symptom score (PAS) and SF-36v2 were carried out, to evaluate the outcome of parathyroidectomy on the psychiatric symptoms of patients. The study included 42 patients of pHPT admitted between November 2007 and December 2009 (two years). Scoring was done preoperatively; and one week, three months, six months, and one year postoperatively. Statistical Analysis Used : SPSS 15 software and nonparametric tests (k Independent Sample test, Kruskal-Wallis H). Results : The mean preoperative PAS score was 430.87 +- 215.61 (range 40 - 880). Statistically significant reduction in scoring was observed postoperatively at one week (293.65 +- 118.31, P < 0.001), three months (109.44 +- 85.09, P < 0.015), six months (70.00 +- 71.65, P 1 < 0.05), and one year (60.10 +- 104.48, P < 0.02). Although the surgery scores for feeling irritability, forgetfulness, difficulty in getting out of chair, headache, and itchy skin did not reduce appreciably at one week, they later showed significant reduction. All other parameters showed significant reduction. The SF-36v2 TM survey also showed significant improvement on all scores except social functioning, while physical functioning improved only after one week. Conclusions : Indian patients with advanced pHPT, after a successful parathyroidectomy, showed significant improvement in their quality of life, as evaluated by the PAS and SF-36v2 systems.