Parathyroidectomy for Primary Hyperparathyroidism in Octogenarians and Nonagenarians: A Risk–Benefit Analysis

Background

The only cure for primary hyperparathyroidism (1°HPT) is parathyroidectomy. However, many elderly patients are not referred for surgery due to medical comorbidities and/or advanced age. The purpose of this study was to evaluate benefits against risks of parathyroidectomy in this patient population.

Materials and methods

From March 2001 to June 2006, 50 patients aged 80 years or older with 1°HPT underwent parathyroidectomy by a single surgeon. Clinical presentation and surgical outcomes of all patients were evaluated. The standard form of the SF-36 Health Survey, designed to measure patient quality of life (QOL), was completed by a subset of patients.

Results

There were 45 females and 5 males with a mean age of 83 ± 2 y. Patient comorbidities included hypertension (72%), coronary artery disease (22%), diabetes mellitus (16%), chronic obstructive pulmonary disease (10%), and congestive heart failure (10%). Bone pain was the most common primary presenting symptom (44%), followed by fatigue (12%), confusion (6%), and joint pain (6%). Eleven patients (22%) had ectopic glands. The cure rate postsurgery was 98% (49/50). There were 2 postoperative complications (4%): one patient with transient hypocalcemia and another with cellulitus at an i.v. site. Of patients who completed QOL surveys, greater than 60% reported improved physical functioning, social functioning, and/or mental health, and reduction of bodily pain.

Conclusion

Parathyroidectomy is safe and curative for octogenarians and nonagenarians with 1°HPT, and maintains or improves quality of life. The surgical benefits outweigh operative risks, making parathyroid surgery an excellent option for patients over 80 years of age.

Key Words: primary hyperparathyroidism, parathyroidectomy, octogenarian, nonagenarian, elderly, quality of life, SF-36