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Health and Quality of Life Outcomes Apr 2024The quality of patient-reported outcome measures (PROMs) used to assess the outcomes of primary hyperparathyroidism (PHPT), a common endocrine disorder that can... (Review)
Review
BACKGROUND
The quality of patient-reported outcome measures (PROMs) used to assess the outcomes of primary hyperparathyroidism (PHPT), a common endocrine disorder that can negatively affect patients' health-related quality of life due to chronic symptoms, has not been rigorously examined. This systematic review aimed to summarize and evaluate evidence on the measurement properties of PROMs used in adult patients with PHPT, and to provide recommendations for appropriate measure selection.
METHODS
After PROSPERO registration (CRD42023438287), Medline, EMBASE, CINAHL Complete, Web of Science, PsycINFO, and Cochrane Trials were searched for full-text articles in English investigating PROM development, pilot studies, or evaluation of at least one PROM measurement property in adult patients with any clinical form of PHPT. Two reviewers independently identified studies for inclusion and conducted the review following the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) Methodology to assess risk of bias, evaluate the quality of measurement properties, and grade the certainty of evidence.
RESULTS
From 4989 records, nine PROM development or validation studies were identified for three PROMs: the SF-36, PAS, and PHPQoL. Though the PAS demonstrated sufficient test-retest reliability and convergent validity, and the PHPQoL sufficient test-retest reliability, convergent validity, and responsiveness, the certainty of evidence was low-to-very low due to risk of bias. All three PROMs lacked sufficient evidence for content validity in patients with PHPT.
CONCLUSIONS
Based upon the available evidence, the SF-36, PAS, and PHPQoL cannot currently be recommended for use in research or clinical care, raising important questions about the conclusions of studies using these PROMs. Further validation studies or the development of more relevant PROMs with strong measurement properties for this patient population are needed.
Topics: Adult; Humans; Quality of Life; Reproducibility of Results; Hyperparathyroidism, Primary; Patient Reported Outcome Measures; Consensus
PubMed: 38566079
DOI: 10.1186/s12955-024-02248-9 -
Gland Surgery Dec 2023Preoperative localization imaging studies are crucial for safe and successful parathyroidectomy in patients with primary hyperparathyroidism (pHPT), especially in...
BACKGROUND
Preoperative localization imaging studies are crucial for safe and successful parathyroidectomy in patients with primary hyperparathyroidism (pHPT), especially in focused approaches. A common imaging sequence is ultrasound followed by scintigraphy. These techniques, but not 18F-fluorocholine positron emission tomography/computed tomography (PET/CT), show lower detection rates in multiglandular disease (MGD), which is associated with smaller adenomas. In this study, we evaluate the accuracy of these modalities in small parathyroid adenomas (PAs) and discuss the potential sequence of preoperative localization diagnostics.
METHODS
Patients undergoing parathyroidectomy for pHPT were retrospectively categorized into small adenoma (specimen diameter <10 mm) and large adenoma. The groups were compared for accuracy of preoperative imaging studies, short-term and long-term outcomes.
RESULTS
Among 147 patients retrospectively analyzed in this study, 38 small PAs were found. Preoperative correct quadrant prediction for small adenomas was significantly lower for ultrasound (P=0.03) and single-photon emission computed tomography/CT (SPECT/CT) (P<0.01) but not for choline PET/CT. While PET/CT was performed significantly more often in small PAs (P<0.01), it showed highly significant superiority over the other imaging modalities in accurate preoperative localization in both small (P<0.0001) and large PAs (P<0.01). There was no difference in calcium and parathyroid hormone (PTH) levels at latest follow-up with slightly more recurrences in small adenomas (P=0.08).
CONCLUSIONS
Choline PET/CT showed a better diagnostic yield especially for small and multiple adenomas and was better in prediction of the correct localization. It could therefore serve as a second-line imaging modality.
PubMed: 38229840
DOI: 10.21037/gs-23-317 -
Journal of the Belgian Society of... 2023We report the case of a 72-year-old patient presenting with recurrent primary hyperparathyroidism after total thyroidectomy and parathyroidectomy with presternal...
UNLABELLED
We report the case of a 72-year-old patient presenting with recurrent primary hyperparathyroidism after total thyroidectomy and parathyroidectomy with presternal autotransplantation. Methionine-PET-CT proved false-positive and Tc-99m-tetrofosmine imaging false-negative. Using a novel multiphase-4DCT technique we identified an anterior mediastinal nodule demonstrating contrast wash-in and wash-out, suggesting parathyroid adenoma. Traditional 4DCT-protocols obtain fewer phases; therefore, this enhancement pattern might have gone unnoticed. After surgical resection the bloodwork normalized, histopathology confirmed a parathyroid adenoma.
TEACHING POINT
Multiphase 4DCT is a potentially helpful technique for the detection of parathyroid adenomas after total thyroidectomy and parathyroidectomy.
PubMed: 37600564
DOI: 10.5334/jbsr.3238 -
International Journal of Surgery... Nov 2023There are few data on outcomes after reintervention for persistent or recurrent primary hyperparathyroidism (PHPT). The authors hypothesized that the variation in...
BACKGROUND
There are few data on outcomes after reintervention for persistent or recurrent primary hyperparathyroidism (PHPT). The authors hypothesized that the variation in outcomes at the hospital level after reoperation would be significant. After accounting for this variability, some patient-level clinical criteria could be identified to help inform treatment decisions in this patient population. The aim of this study was to determine whether there is significant variation in outcomes after reoperation for PHPT between hospitals (hospital-level analysis) and identify clinical factors (patient-level analysis) that influence postoperative outcomes.
MATERIALS AND METHODS
This retrospective multicenter cohort study was performed using the Eurocrine registry. Data from 11 countries and 76 hospitals from January 2015 to October 2020 were extracted. A generalized linear mixed model was used to assess the variation in outcomes at the hospital level and to identify risk factors of postoperative outcomes at the patient level. The primary endpoint (textbook outcome) was achieved when all six of the following postoperative conditions were met: no hypocalcemia or persistent hypercalcemia, no laryngeal nerve injury, no negative exploration, no normal parathyroid gland only on histopathology, and no postoperative death.
RESULTS
Among 13 593 patients who underwent parathyroidectomy for PHPT, 617 (4.5%) underwent reoperative parathyroidectomy. At follow-up, 231 patients (37.4%) were hypocalcemic, 346 (56.1%) were normocalcemic without treatment, and 40 (6.5%) had persistent hypercalcemia. Textbook outcomes were achieved in 321 (52.0%) patients. The hospital-level variation in textbook outcome rates was significant ( P <0.001), and this variation could explain 29.1% of the observed outcomes. The criterion that remained significant after controlling for inter-hospital variation was 'a single lesion on sestamibi scan or positron emission tomography (PET) imaging' (odds ratio 2.08, 95% confidence interval 1.24-3.48; P =0.005).
CONCLUSION
Outcomes after reoperation are significantly associated with hospital-related factors. A 'single lesion observed on preoperative sestamibi scan or PET' appears relevant to select patients before reoperation.
Topics: Humans; Hyperparathyroidism, Primary; Hypercalcemia; Reoperation; Cohort Studies; Parathyroid Glands; Parathyroidectomy; Retrospective Studies; Technetium Tc 99m Sestamibi; Parathyroid Hormone
PubMed: 37578454
DOI: 10.1097/JS9.0000000000000613 -
The Journal of Surgical Research Aug 2023We sought to investigate the association of concurrent parathyroidectomy (PTX) with risks of total thyroidectomy (TTX) through analysis of Collaborative Endocrine...
INTRODUCTION
We sought to investigate the association of concurrent parathyroidectomy (PTX) with risks of total thyroidectomy (TTX) through analysis of Collaborative Endocrine Surgery Quality Improvement Program data. TTXis a common operation with complications including recurrent laryngeal nerve injury, neck hematoma, and hypoparathyroidism. A subset of patients undergoing thyroidectomy undergoes planned concurrent PTX for treatment of primary hyperparathyroidism. There are limited data on the risk profile of TTX with concurrent PTX (TTX + PTX).
METHODS
We queried the Collaborative Endocrine Surgery Quality Improvement Program database for patients who underwent TTX or TTX + PTX from January 2014 through April 2020. Multivariable logistic regression was performed to predict hypoparathyroidism, vocal cord dysfunction, neck hematoma, and postoperative emergency department visit. Covariates included patient demographics, patient body mass index, indication for surgery, central neck dissection, anticoagulation use, and surgeon volume.
RESULTS
Thirteen thousand six hundred forty seven patients underwent TTX and 654 patients underwent TTX + PTX. Unadjusted rates of hypoparathyroidism were higher in TTX + PTX patients at 30 d (9.6% versus 7.4%, P = 0.04) and 6 mo (7.9% versus 3.1%, P < 0.001). On multivariable regression, TTX + PTX was associated with an increased risk of hypoparathyroidism at 30 d (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.57-2.79) and 6 mo (OR 4.63, 95% CI 3.06-7.00) and an increased risk of postoperative emergency department visit (OR 1.66, 95% CI 1.20-2.31). TTX + PTX was not associated with recurrent laryngeal nerve injury or neck hematoma.
CONCLUSIONS
Concurrent PTX in patients undergoing TTX is associated with increased risk of immediate and long-term hypoparathyroidism, which should be considered in informed consent discussions and operative decision-making.
Topics: Humans; Parathyroidectomy; Thyroidectomy; Recurrent Laryngeal Nerve Injuries; Hypoparathyroidism; Hematoma; Postoperative Complications; Retrospective Studies
PubMed: 37043874
DOI: 10.1016/j.jss.2023.02.036 -
Quantitative Imaging in Medicine and... Dec 2023Exact preoperative localization is desirable to perform minimally invasive parathyroidectomy for hyperparathyroidism (HPT). This study aimed to evaluate the diagnostic...
BACKGROUND
Exact preoperative localization is desirable to perform minimally invasive parathyroidectomy for hyperparathyroidism (HPT). This study aimed to evaluate the diagnostic values of Tc-methoxyisobutylisonitrile (Tc-MIBI) single photon emission computed tomography/computed tomography (SPECT/CT) of parathyroid glands by analyzing the relationship between lesion weight and false-negative (FN) results, as well as to explain the possible reason.
METHODS
The data from 314 patients with suspected HPT who underwent Tc-MIBI SPECT/CT parathyroid imaging between 2011 and 2022 were retrospectively evaluated. The sensitivity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of parathyroid Tc-MIBI SPECT/CT were calculated, and the false-positive (FP) and FN findings were analyzed.
RESULTS
Accurate localization by Tc-MIBI SPECT/CT was significantly associated with the parathyroid hormone (PTH) level. The Tc-MIBI SPECT/CT for diagnosis/lesion location reached a sensitivity of 84.6%/56.8%, a PPV of 97.3%/98.4%, an NPV of only 23.7%/4.18%, and an accuracy of 83.4%/57.1%, respectively. The largest diameter, shortest diameter, and lesion volume were lower in the FN group than in the TP group. A total of 7 FP cases were found, including 2 cases of thyroid nodules, 4 cases of thyroid tissue, and 1 case of hibernoma. A total of 45 FN patients, including 321 FN lesions, were confirmed, of which parathyroid hyperplasia accounted for 97.8%. Lesion weights greater than 20 µg were able to be detected, but lightweight lesions less than 100 mg were the principal source of FN results, accounting for approximately 39.3%. With lesion weights 0-100, 101-300, 301-1,000, and >1,000 mg, the FN rate was 70.8% (126/178), 51.8% (103/199), 34.6% (81/234), and 8.33% (11/132), respectively.
CONCLUSIONS
Tc-MIBI SPECT/CT parathyroid imaging provides good sensitivity and high specificity in HPT location. Correct localization by Tc-MIBI SPECT/CT correlates positively with lesion weight and PTH levels. The smaller the lesion, the higher the FN rate in Tc-MIBI SPECT/CT parathyroid imaging, and lesions weighing less than 100 mg are the main source of FN results in Tc-MIBI SPECT/CT parathyroid imaging.
PubMed: 38106262
DOI: 10.21037/qims-23-1091 -
Jornal Brasileiro de Nefrologia 2023For the reduction of PTH levels, two classes of drugs are available in the Brazilian market: non-selective and selective vitamin D receptor activators and calcimimetics....
INTRODUCTION
For the reduction of PTH levels, two classes of drugs are available in the Brazilian market: non-selective and selective vitamin D receptor activators and calcimimetics. Among the mentioned drugs, the SUS provides oral calcitriol, paricalcitol and cinacalcet.
OBJECTIVES
Develop cost-effectiveness (CE) and budgetary impact (BI) analysis of cinacalcet versus paricalcitol for patients on dialysis with SHPT, from the perspective of SUS.
METHODOLOGY
A decision tree model was constructed for CE analysis, which considered the outcome of avoided parathyroidectomy and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of which was measured demand and other epidemiological, based on data from the Brazilian Society of Nephrology (BSN).
RESULTS
The CE analysis showed that the use of cinacalcet results in one-off savings of R$1,394.64 per year and an incremental effectiveness of 0.08, in relation to avoided parathyroidectomy. The incremental CE ratio (ICER) was - R$ 17,653.67 per avoided parathyroidectomy for cinacalcet, as it was more effective and cheaper compared to paricalcitol. As for the BI analysis, it was estimated that the incremental BI with the expansion of the use of cinacalcet in the SUS will be between - R$ 1,640,864.62 and R$ 166,368.50 in the first year, considering the main and the epidemiological scenarios. At the end of 5 years after the expansion of use, an BI was estimated between - R$ 10,740,743.86 and - R$ 1,191,339.37; considering the same scenarios.
CONCLUSION
Cinacalcet was dominant to avoid parathyroidectomies, being cost-effective.
Topics: Humans; Cinacalcet; Cost-Effectiveness Analysis; Hyperparathyroidism, Secondary; Naphthalenes; Renal Dialysis; Cost-Benefit Analysis; Renal Insufficiency, Chronic; Parathyroid Hormone
PubMed: 37015047
DOI: 10.1590/2175-8239-JBN-2022-0126en -
BJS Open Jan 2024Substantial disparities in the utilization of parathyroidectomy for primary hyperparathyroidism have been reported. This study aimed to analyse regional variations in...
BACKGROUND
Substantial disparities in the utilization of parathyroidectomy for primary hyperparathyroidism have been reported. This study aimed to analyse regional variations in parathyroidectomy incidence with respect to the patient's disease burden and socioeconomic status.
METHODS
A population-based case-control study included all patients with primary hyperparathyroidism who underwent parathyroidectomy in Sweden between 2008 and 2017 and 10 matched controls. Data on demographic and socioeconomic variables, co-morbidities and drug prescriptions were collected from relevant national registers. Conditional logistic regression was used to analyse predictors of parathyroidectomy.
RESULTS
A total of 8626 patients with primary hyperparathyroidism (77% women) underwent parathyroidectomy during the study interval. The annual incidence of parathyroidectomy was 9.0 per 100 000 persons. The annual age-adjusted regional incidences of parathyroidectomy varied between 3.3 and 16.9 operations per 100 000 inhabitants. Except for a small underrepresentation of patients with lower education, no effect of socioeconomic variables was observed. Compared with matched controls, the parathyroidectomy group had increased odds ratios of having developed classical symptoms of primary hyperparathyroidism and being prescribed medication against cardiovascular disorders and psychiatric illness at the time of parathyroidectomy. Increased risks of kidney stones and osteoporosis were observed 5 years before parathyroidectomy. Patients with primary hyperparathyroidism selected for parathyroidectomy from regions with a low incidence of operations had a higher prevalence of kidney stones, osteoporosis and hypertension, as well as larger adenomas and higher calcium levels at the time of parathyroidectomy compared with patients in high-incidence regions.
CONCLUSION
The considerable variation in parathyroidectomy seems more likely associated with different clinical thresholds for detection of primary hyperparathyroidism and referral to surgery than socioeconomic disparities.
Topics: Humans; Female; Male; Sweden; Case-Control Studies; Hyperparathyroidism, Primary; Kidney Calculi; Osteoporosis
PubMed: 38323883
DOI: 10.1093/bjsopen/zrad154 -
Orthopaedic Surgery Nov 2023Primary hyperparathyroidism (PHPT) is an endocrine disorder with high serum calcium and parathyroid hormone (PTH) levels. Excessive secretion of PTH can cause bone loss...
BACKGROUND
Primary hyperparathyroidism (PHPT) is an endocrine disorder with high serum calcium and parathyroid hormone (PTH) levels. Excessive secretion of PTH can cause bone loss and may have potential damage to implant fixation after total knee arthroplasty (TKA). However, there is currently no research or literature reporting prosthesis loosening after TKA associated with PHPT.
CASE PRESENTATION
This case report describes a TKA failure of tibial prothesis loosening associated with PHPT. The patient faced aggravated pain and difficulty in walking 6 months after the primary TKA. Further examinations showed high serum calcium and PTH levels indicating the presence of PHPT. After the surgery of parathyroidectomy, the patient received revision TKA with 3D-printed metaphyseal cone. Knee symptoms and function were finally improved.
CONCLUSION
PHPT is a risk factor for prosthesis loosening after TKA. Preoperative screening test of serum calcium and PTH levels is important to diagnose PHPT. For patients with PHPT undergoing TKA, preoperative endocrinotherapy and parathyroidectomy are recommended to improve the survival of prosthesis.
Topics: Humans; Arthroplasty, Replacement, Knee; Calcium; Hyperparathyroidism, Primary; Prosthesis Failure; Parathyroid Hormone
PubMed: 37749766
DOI: 10.1111/os.13892 -
BMC Surgery Aug 2023Parathyroidectomy (PTX) is commonly performed as a treatment for secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease (ESRD). We aimed to...
PURPOSE
Parathyroidectomy (PTX) is commonly performed as a treatment for secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease (ESRD). We aimed to evaluate the efficacy of PTX in patients with SHPT who underwent hemodialysis.
METHODS
This retrospective study analyzed the clinical treatment of 80 hemodialysis patients with SHPT who underwent either total PTX with forearm auto transplantation (TPTX + AT) or subtotal parathyroidectomy (SPTX). We compared the changes in biochemical indices before and after surgery as well as the attenuation of intact parathyroid hormone (iPTH) in the TPTX and SPTX groups. We also evaluated clinical symptoms and quality of life using the Visual Analog Scale (VAS) and the Short Form-36 Questionnaire (SF-36) before and at 3, 6, and 12 months after surgery.
RESULTS
Serum iPTH and serum phosphorus levels decreased significantly after surgery in 80 patients with SHPT (P < 0.05). Within one month of surgery, there was a difference in iPTH levels between the TPTX + AT and SPTH groups, but there was no difference over time. Patients experienced significant improvement in their clinical symptoms of restless leg syndrome, skin itching, bone pain, and joint pain at 1 week post operation (P < 0.001). Quality of life significantly improved after surgery, as assessed by SF-36 scores (P < 0.05). Hypocalcemia was the most common postoperative complication, occurring in 35% of patients. Within the first 12 months post surgery, 5 patients had a recurrence.
CONCLUSION
PTX is effective in rapidly reducing iPTH levels, improving calcium and phosphorus metabolism disorders, and enhancing patients' quality of life by safely and effectively relieving clinical symptoms.
Topics: Humans; Parathyroidectomy; Retrospective Studies; Parathyroid Glands; Quality of Life; Transplantation, Autologous; Hyperparathyroidism, Secondary; Renal Dialysis; Parathyroid Hormone
PubMed: 37568150
DOI: 10.1186/s12893-023-02143-y