Endocrine| Volume 158, ISSUE 3, P837-845, September 2015

Improvement in patient-reported physical and mental health after parathyroidectomy for primary hyperparathyroidism


      The majority of patients with primary hyperparathyroidism (PHPT) are diagnosed without the classic signs of renal or osseous complications. Vague and subjective symptoms have been attributed to PHPT but have been difficult to measure during the medical encounter. The Patient-Reported Outcomes Measurement Information System (PROMIS) of the National Institutes of Health contains validated measures of physical and mental health that can be administered by the use of computer-adaptive testing (CAT). The objective of this study was to evaluate the feasibility of PROMIS assessment in the clinical setting to measure changes in patient-reported health before and after parathyroidectomy. We hypothesized that patients undergoing parathyroidectomy for PHPT would report greater improvement in mental and physical health compared with control patients.


      Adult PHPT patients scheduled for parathyroidectomy and control patients requiring diagnostic thyroid operation were enrolled prospectively during a 6-month period. Patients were administered clinically relevant PROMIS health domains via CAT at a preoperative visit and 3 weeks after operation. A change in score of 5 or greater for each PROMIS instrument was defined as clinically important. Statistical significance of pre/post-surgery changes in scores was determined using paired t tests.


      A total of 35 patients with PHPT and 9 control patients completed the study. The mean number of PROMIS items answered during an assessment was 67 (range 51–121, SD 15.4). Median completion time was 8.2 minutes (range 3.4–38.4, SD 4.7). Clinically important improvement after parathyroidectomy in the PHPT group was greater than in the control group in 5 PROMIS domains. The score improvement experienced by PHPT patients was 8.8 in Fatigue, 6.7 in Sleep-Related Impairment, 5.0 in Anxiety, 7.0 in Applied Cognition, and 6.2 in Depression (all P < .05).


      PROMIS is an efficient clinical assessment platform for measuring patient-reported outcomes in PHPT via CAT. Several domains of physical and mental health in patients with PHPT show statistically and clinically important improvement after parathyroidectomy.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sosa J.A.
        • Udelsman R.
        The parathyroid glands.
        in: Townsend C.M. Sabiston textbook of surgery: the biological basis of modern surgical practice. 19th ed. Elsevier Saunders, Philadelphia, PA2012
        • Bilezikian J.P.
        • Brandi M.L.
        • Eastell R.
        • et al.
        Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop.
        J Clin Endocrinol Metab. 2014; 99: 3561-3569
        • Burney R.E.
        • Jones K.R.
        • Christy B.
        • Thompson N.W.
        Health status improvement after surgical correction of primary hyperparathyroidism in patients with high and low preoperative calcium levels.
        Surgery. 1999; 125: 608-614
        • Zanocco K.
        • Angelos P.
        • Sturgeon C.
        Cost-effectiveness analysis of parathyroidectomy for asymptomatic primary hyperparathyroidism.
        Surgery. 2006; 140 (discussion 881–882): 874-881
        • Zanocco K.
        • Sturgeon C.
        How should age at diagnosis impact treatment strategy in asymptomatic primary hyperparathyroidism? A cost-effectiveness analysis.
        Surgery. 2008; 144: 290-298
        • Eigelberger M.S.
        • Cheah W.K.
        • Ituarte P.H.
        • Streja L.
        • Duh Q.Y.
        • Clark O.H.
        The NIH criteria for parathyroidectomy in asymptomatic primary hyperparathyroidism: are they too limited?.
        Ann Surg. 2004; 239: 528-535
        • Silverberg S.J.
        • Shane E.
        • Jacobs T.P.
        • Siris E.
        • Bilezikian J.P.
        A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery.
        N Engl J Med. 1999; 341: 1249-1255
        • Bilezikian J.P.
        • Khan A.A.
        • Potts Jr., J.T.
        Third International Workshop on the Management of Asymptomatic Primary H. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop.
        J Clin Endocrinol Metab. 2009; 94: 335-339
        • Macfarlane D.P.
        • Yu N.
        • Donnan P.T.
        • Leese G.P.
        Should 'mild primary hyperparathyroidism' be reclassified as 'insidious': is it time to reconsider?.
        Clin Endocrinol. 2011; 75: 730-737
        • Roman S.A.
        • Sosa J.A.
        • Mayes L.
        • et al.
        Parathyroidectomy improves neurocognitive deficits in patients with primary hyperparathyroidism.
        Surgery. 2005; 138 (discussion 1128–9): 1121-1128
        • Udelsman R.
        • Pasieka J.L.
        • Sturgeon C.
        • Young J.E.
        • Clark O.H.
        Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop.
        J Clin Endocrinol Metab. 2009; 94: 366-372
        • Cella D.
        • Riley W.
        • Stone A.
        • et al.
        The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008.
        J Clin Epidemiol. 2010; 63: 1179-1194
        • Silverberg S.J.
        • Lewiecki E.M.
        • Mosekilde L.
        • Peacock M.
        • Rubin M.R.
        Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop.
        J Clin Endocrinol Metab. 2009; 94: 351-365
        • Weber T.
        • Keller M.
        • Hense I.
        • et al.
        Effect of parathyroidectomy on quality of life and neuropsychological symptoms in primary hyperparathyroidism.
        World J Surg. 2007; 31: 1202-1209
        • Coker L.H.
        • Rorie K.
        • Cantley L.
        • et al.
        Primary hyperparathyroidism, cognition, and health-related quality of life.
        Ann Surg. 2005; 242: 642-650
        • Yost K.J.
        • Eton D.T.
        • Garcia S.F.
        • Cella D.
        Minimally important differences were estimated for six Patient-Reported Outcomes Measurement Information System-Cancer scales in advanced-stage cancer patients.
        J Clin Epidemiol. 2011; 64: 507-516
        • Rao D.S.
        • Phillips E.R.
        • Divine G.W.
        • Talpos G.B.
        Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism.
        J Clin Endocrinol Metab. 2004; 89: 5415-5422
        • Bollerslev J.
        • Jansson S.
        • Mollerup C.L.
        • et al.
        Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial.
        J Clin Endocrinol Metab. 2007; 92: 1687-1692
        • Ambrogini E.
        • Cetani F.
        • Cianferotti L.
        • et al.
        Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial.
        J Clin Endocrinol Metab. 2007; 92: 3114-3121
        • McHorney C.A.
        • Ware Jr., J.E.
        • Raczek A.E.
        The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.
        Med Care. 1993; 31: 247-263
        • Ware Jr., J.E.
        • Sherbourne C.D.
        The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
        Medical Care. 1992; 30: 473-483
        • Pasieka J.L.
        • Parsons L.L.
        Prospective surgical outcome study of relief of symptoms following surgery in patients with primary hyperparathyroidism.
        World J Surg. 1998; 22 (discussion 518–519): 513-518
        • Pasieka J.L.
        • Parsons L.L.
        • Demeure M.J.
        • et al.
        Patient-based surgical outcome tool demonstrating alleviation of symptoms following parathyroidectomy in patients with primary hyperparathyroidism.
        World J Surg. 2002; 26: 942-949
        • Pasieka J.L.
        • Parsons L.
        • Jones J.
        The long-term benefit of parathyroidectomy in primary hyperparathyroidism: a 10-year prospective surgical outcome study.
        Surgery. 2009; 146: 1006-1013
        • Kahal H.
        • Aye M.
        • Rigby A.S.
        • Sathyapalan T.
        • England R.J.
        • Atkin S.L.
        The effect of parathyroidectomy on neuropsychological symptoms and biochemical parameters in patients with asymptomatic primary hyperparathyroidism.
        Clin Endocrinol. 2012; 76: 196-200
        • Tsukahara K.
        • Sugitani I.
        • Fujimoto Y.
        • Kawabata K.
        Surgery did not improve the subjective neuropsychological symptoms of patients with incidentally detected mild primary hyperparathyroidism.
        Eur Arch Otorhinolaryngol. 2008; 265: 565-569