Parathyroidectomy improves depression symptoms in primary hyperparathyroidism
A cohort of adults with primary hyperparathyroidism and depression experienced an improvement in both somatic and cognitive depressive symptoms after undergoing successful parathyroidectomy, regardless of the severity of disease at baseline, according to findings from a case-control study published in Clinical Endocrinology.
“Investigations demonstrating improved neurocognitive function after parathyroidectomy have not found a consistent association with preoperative biochemical parameters of [primary hyperparathyroidism],” Ann E. Kearns, MD, PhD, associate professor of medicine in the division of endocrinology, diabetes, nutrition and metabolism at the Mayo Clinic College of Medicine in Rochester, Minnesota, and colleagues wrote in the study background. “Defining the predictors of improvement would facilitate patient selection for surgery and improved counseling of patients undergoing parathyroidectomy about which symptoms are most likely to respond.”
Kearns and colleagues analyzed data from 88 patients with primary hyperparathyroidism undergoing parathyroidectomy (cases; mean age, 65 years; 85.2% women) and 85 patients with benign, nontoxic thyroid disease undergoing thyroid surgery (controls; mean age, 54 years; 80% women), prospectively recruited between June 2008 and June 2009. Patients completed the Patient Health Questionnaire-9 (PHQ-9) at recruitment and after surgery via phone interviews. Questionnaire items were stratified by cognitive categories (depressed mood, negative feelings, difficulty concentrating and suicidal ideation) and somatic categories (problems with sleep, appetite change and psychomotor agitation) and compared between cases and controls. Researchers used linear regression models to analyze associations between baseline biochemical results (vitamin D level, parathyroid hormone level, serum calcium and serum creatinine), clinical characteristics and baseline depression scores compared with findings at 12 months.
At baseline, PHQ-9 scores were higher for patients in the parathyroidectomy group vs. the thyroid surgery group (median, 7.5 vs. median, 3; P < .0001), as were both cognitive and somatic PHQ-9 symptom group scores, according to researchers. At 12 months, all PHQ-9 scores, including total, somatic and cognitive scores, were lower vs. baseline in both the parathyroidectomy and thyroid surgery groups, with no between-group differences persisting at follow-up. Patients in the parathyroidectomy with clinically significant PHQ-9 scores ( 10) declined from 43% to 7.6% (P < .001) at 12 months.
“The number of individuals indicating ‘not at all’ to each specific item increased after surgery in both [primary hyperparathyroidism] and thyroid patients, and no item was significantly different between the groups 1 year after surgery,” the researchers wrote.
The researchers noted that patients with primary hyperparathyroidism and high depression scores, assessed via the PHQ-9, should be considered for parathyroidectomy because depression scores are likely to improve, regardless of the biochemical severity of primary hyperparathyroidism.
“Furthermore, change in depression scores are not strongly related to the degree of calcium of [parathyroid hormone] elevation, suggesting that even patients with relatively mild hypercalcemia can have improvement in PHQ-9 scores following parathyroid surgery,” the researchers wrote. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.