Surgery. 2025 Nov 3:109867. doi: 10.1016/j.surg.2025.109867. Online ahead of print.
ABSTRACT
BACKGROUND: Primary hyperparathyroidism has been linked to an increased prevalence of neuropsychiatric disorders. However, there is sparse literature to determine if parathyroidectomy improves the development of new-onset conditions when compared to nonoperative management. This project aims to assess the impact of parathyroidectomy on new-onset neuropsychiatric disorders.
METHODS: Using data from a multi-institutional database, a retrospective cohort was conducted on patients classified with an International Classification of Diseases, Tenth Revision, of primary hyperparathyroidism (E21.0) aged 18 years or older with at least 3 years of follow-up after diagnosis. The study compared those with a previous parathyroidectomy (Current Procedural Terminology code 60500) to those with nonsurgical management. A regression analysis was conducted to compare cohorts and calculate the hazard ratio of developing neuropsychiatric disorders based on International Classification of Diseases, Tenth Revision, codes.
RESULTS: The initial query identified 51,983 patients with primary hyperparathyroidism. After matching, 37,194 patients were included and were predominantly White (73.4%, n = 27,324) and female (74.1%, n = 27,582). The parathyroidectomy and nonsurgical groups both contained 18,597 patients, with an average age of 60 ± 13 years. Patients who underwent parathyroidectomy had significantly lower rates of anxiety (hazard ratio 0.72, 95% confidence interval 0.67-0.78), depression (0.76, 0.70-0.84), mania or bipolar disorder (0.45, 0.30-0.67), and mild cognitive decline (0.73, 0.58-0.91) than their nonsurgical counterparts. There was no difference between the groups regarding new-onset schizophrenia (hazard ratio 0.81, 95% confidence interval 0.37-1.80), somnolence (0.87, 0.74-1.02), and suicidal ideation (0.65, 0.41-1.02).
CONCLUSIONS: Parathyroidectomy was associated with significantly lower rates of new-onset neuropsychiatric disorders in patients with primary hyperparathyroidism compared with medical management.
PMID:41188138 | DOI:10.1016/j.surg.2025.109867
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