Prä- und postoperative Lebensqualität, Angst und Depressivität beim primären Hyperparathyreoidismus im Vergleich zu einer Kontrollgruppe benigner Strumen - Ergebnisse einer prospektiven Multizenterstudie

Abstract

Current guidelines recommend surgery as a curative option for symptomatic primary hyperparathyroidism (pHPT). A relevant number of pHPT patients, however, present non-specific symptoms e.g. fatigue, mood swings or depression, and are sometimes misclassified as “asymptomatic”. This prospective multicenter study investigated pre- and postoperative anxiety, depression and health-related quality of life (HRQOL) in pHPT patients and compared them to a control group with nontoxic thyroid nodules. Depression was evaluated with the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ-9), which also assessed suicidal ideation. Anxiety was evaluated with the HADS. HRQOL was measured with the 36-item short form survey (SF-36). The study included 194 pHPT patients and 186 controls. Both groups were > 70% female; mean age was 58.5 (51.1) years for patients with pHPT (controls). Parathyroidectomy achieved a 98% cure rate. Preoperatively, moderate symptoms of depression (> 11- point HADS score) were seen in 20% (9%) of the pHPT group (controls). The PHQ-9 detected moderately to severe depression in 17% (7%) of pHPT patients (controls). pHPT patients showed higher HADS anxiety scores (mean 7.7) than did controls (p<0.01) or the German normative sample (p < 0.001). Compared to controls, pHPT patients had significantly lower SF-36 preoperative physical and mental health summary scores (42.7 vs. 49.5, 41.2 vs. 46.8, p = 0.001 for both comparisons) respectively. At 12 months´ follow-up, depression and anxiety decreased significantly in patients with pHPT; prevalence of suicidal ideation was more than halved from the baseline (10.7% vs. 22%, p =). Both physical and mental health scores (45.7, 47.7 respectively) improved in pHPT patients (p < 0.001, each), but not in controls. Depression, anxiety, and decreased HRQOL appear to be related to pHPT. Successful parathyroidectomy seems to reduce psychopathological symptoms and improve HRQOL in this setting.