Surgery fails to reduce morbidity or mortality in mild hyperparathyroidism

Norway: Parathyroidectomy in middle-aged and older patients with mild asymptomatic primary hyperparathyroidism (PHPT) does not appear to reduce morbidity or mortality, according to results from a 10-Year Prospective Randomized Controlled Trial of Parathyroidectomy Versus Observation. Further, no evidence of adverse effects of observation was seen for at least a decade. 

In simpler words, mild primary hyperparathyroidism (PHPT) patients do well with observation alone. When patients opt for surgery, they should be referred to surgeons who are experienced in modern, minimally invasive techniques. The study was published in the journal Annals of Internal Medicine on 19 April 2022. 

Primary hyperparathyroidism is a common endocrine disorder tied to an increased risk of cardiovascular disease, fractures, kidney disease, mortality, and cancer. In mild PHPT with modest hypercalcemia and without known morbidities, parathyroidectomy (PTX) is debated as no long-term randomized trials have been performed.

To fill this knowledge gap, Mikkel Pretorius, University of Oslo, Oslo, Norway, and colleagues aimed to examine the effect of PTX on mild PHPT with regard to mortality (primary endpoint) and key morbidities (secondary endpoint) in a prospective randomized controlled trial. 

The trial was set across eight Scandinavian referral centers. It included 191 patients with mild PHPT from 1998 to 2005. Ninety-five patients were randomly assigned to PTX, and 96 were assigned to observation without intervention (OBS). 

The researchers obtained data and causes of death from the Swedish and Norwegian Cause of Death Registries 10 years after randomization and after an extended observation period lasting until 2018. Morbidity events were prospectively registered annually.