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Medical Observation, Compared with Parathyroidectomy, for Asymptomatic Primary Hyperparathyroidism: A Prospective, Randomized Trial

Section of Endocrinology (J.B., G.A.I., T.U.), Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, N-0027 Oslo, Norway; Departments of Surgery (S.J.) and Endocrinology (C.F., T.R.), Sahlgrenska Hospital, S-416 85 Gothenburg, Sweden; Department of Endocrine Surgery (C.L.M.), Copenhagen University Hospital, DK-2100 Rigshospitalet, Denmark; Department of Surgery (J.N.), Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; Department of Surgery (E.L.), Akademiska Hospital, SE-751 85 Uppsala, Sweden; Section of Endocrinology (O.T.), Department of Medicine, Södersjukhuset, SE-118 83 Stockholm, Sweden; Departments of Surgery (J.-E.V.) and Endocrinology (S.A.), Haukeland University Hospital and Institute of Medicine, University of Bergen, N-5021 Bergen, Norway; Department of Medicine (M.B.), St. Olav’s Hospital, University of Trondheim, 7006 Trondheim, Norway; and Department of Metabolism and Endocrinology (B.F.), Karolinska University Hospital, SE-141 86 Huddinge, Sweden

Address all correspondence and requests for reprints to: Jens Bollerslev, M.D., D.Med.Sci., Section of Endocrinology, Department of Medicine, National University Hospital, N-0027 Oslo, Norway. E-mail: jens.bollerslev{at}medisin.uio.no.

Context: The clinical presentation of primary hyperparathyroidism (pHPT) has changed during the last half century, and the diagnosis is now more often made by chance in patients with no specific symptoms.

Objective: The present study is a randomized, controlled trial that investigates the effects of parathyroidectomy or medical observation in mild asymptomatic pHPT on morbidity and quality of life (QoL).

Design/Setting/Patients: A total of 191 patients (26 men) with asymptomatic pHPT [mean age 64.2 ± 7.4 (SD) yr] were recruited in the study and randomized to medical observation (serum calcium level 2.69 ± 0.08 mmol/liter) or surgery (2.70 ± 0.08 mmol/liter). We here report baseline and 1 (n = 119) and 2 yr data (n = 99) on those who had completed the follow-up visits by the end of the inclusion period.

Results: At baseline, the patients had significantly lower QoL (SF-36) and more psychological symptoms, compared with age- and sex-matched healthy subjects. The two groups were similar at baseline, and no clinically significant changes in these parameters were seen during the observation time. Calcium and PTH normalized after surgery. The areal bone mineral density increased in the group randomized to operation, whereas the bone mineral density remained stable in the medical observation group. No change in kidney function (creatinine) or blood pressure was observed longitudinally or between the groups.

Conclusions: Asymptomatic patients with mild pHPT have decreased QoL and more psychological symptoms than normal controls. No benefit of operative treatment, compared with medical observation, was found on these measures so far.

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