Our Summary

This study looked at how often a surgical procedure known as parathyroidectomy was used to treat a common condition called primary hyperparathyroidism (PHPT) in older adults. PHPT is a condition where the body produces too much parathyroid hormone, which can lead to problems like fractures, kidney stones, and chronic kidney disease. Surgery is the most effective treatment for PHPT.

The researchers looked at Medicare data from over 200,000 patients diagnosed with PHPT between 2006 and 2016. They found that only 30% of these patients had surgery within a year of their diagnosis. Even among patients who met the guidelines for having the surgery, only about 30% actually had the operation.

The study found that patients who had the surgery were generally younger, healthier, and more likely to be white. They were also more likely to live in rural and socioeconomically disadvantaged areas. Patients who were older, frailer, and had more health problems were less likely to have the operation.

Interestingly, having kidney stones increased the chances of having the surgery, while having stage 3 chronic kidney disease decreased the chances. Having osteoporosis didn’t seem to affect the decision to have surgery.

In summary, most older adults with PHPT are not getting the most effective treatment for their condition. More research is needed to find out why this is and how we can make sure more people who could benefit from the surgery actually get it.

FAQs

  1. What is a parathyroidectomy and when is it used?
  2. What percentage of older adults diagnosed with PHPT undergo surgery within a year of their diagnosis according to the study?
  3. Did the study find any factors that influenced whether or not a patient with PHPT would undergo surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about parathyroidectomy is to discuss the potential benefits and risks of the surgery with their healthcare provider. It’s important to understand that surgery is the most effective treatment for primary hyperparathyroidism and can help improve symptoms and prevent complications like fractures and kidney stones. Patients should also be aware that the decision to have surgery may depend on their overall health and individual circumstances, and it’s important to have open communication with their healthcare team to make an informed decision about their treatment options.

Suitable For

Patients who are younger, healthier, white, and living in rural or socioeconomically disadvantaged areas are more likely to be recommended for parathyroidectomy. Additionally, patients with kidney stones are more likely to undergo the surgery, while those with stage 3 chronic kidney disease are less likely to have the operation. Patients with osteoporosis do not seem to have a significant impact on the decision to have surgery. Older, frailer patients with more health problems are less likely to be recommended for parathyroidectomy. More research is needed to understand why certain patients are not receiving this effective treatment for primary hyperparathyroidism.

Timeline

Timeline of a patient’s experience before and after parathyroidectomy:

Before surgery:

  • Patient is diagnosed with primary hyperparathyroidism (PHPT) through blood tests and imaging studies.
  • Patient may experience symptoms such as fatigue, bone pain, kidney stones, and frequent urination.
  • Patient may undergo additional tests to determine the severity of their condition and assess their overall health.
  • Patient may be prescribed medications to manage symptoms and prevent complications.
  • Patient may consult with an endocrinologist and a surgeon to discuss treatment options, including surgery.

After surgery:

  • Patient undergoes parathyroidectomy to remove the overactive parathyroid gland(s).
  • Patient stays in the hospital for a few days for monitoring and recovery.
  • Patient may experience temporary changes in calcium levels and may need to take calcium and vitamin D supplements.
  • Patient may need to follow up with their surgeon and endocrinologist for monitoring of calcium levels and overall health.
  • Patient may experience improvement in symptoms such as bone pain, fatigue, and kidney stones.
  • Patient may need to make lifestyle changes, such as increasing calcium intake and staying hydrated, to prevent recurrence of PHPT.

Overall, parathyroidectomy can effectively treat PHPT and improve quality of life for patients, but it is important for patients to be properly evaluated and informed about their treatment options.

What to Ask Your Doctor

Some questions a patient should ask their doctor about parathyroidectomy include:

  1. What are the risks and benefits of having a parathyroidectomy for my condition?
  2. What criteria do I need to meet in order to be a candidate for parathyroidectomy?
  3. How soon should I have the surgery after being diagnosed with primary hyperparathyroidism?
  4. Are there any alternative treatments to surgery that I should consider?
  5. What is the success rate of parathyroidectomy in treating primary hyperparathyroidism?
  6. How long is the recovery process after parathyroidectomy and what can I expect during that time?
  7. Will I need to take any medication or make lifestyle changes after the surgery?
  8. How often will I need to follow up with you after the surgery?
  9. Are there any long-term effects or complications I should be aware of after having a parathyroidectomy?
  10. Can you explain the reasons why some patients with PHPT do not undergo parathyroidectomy and if this applies to me?

Reference

Authors: Seib CD, Suh I, Meng T, Trickey A, Smith AK, Finlayson E, Covinsky KE, Kurella Tamura M, Kebebew E. Journal: JAMA Surg. 2021 Apr 1;156(4):334-342. doi: 10.1001/jamasurg.2020.6175. PMID: 33404646