Randomized trial of parathyroidectomy in mild asymptomatic primary hyperparathyroidism: Patient description and effects on the SF-36 health survey

Background. The treatment of patients with asymptomatic primary hyperparath yroidism remains controversial despite a National Institutes of Health cons ensus statement. This statement also recommended a randomized clinical tria l because none exists to address this issue. Methods. Informed consent was obtained from 53 asymptomatic patients with c onfirmed asymptomatic primary hyperparathyroidism who participated in this randomized trial of parathyroidectomy versus observation. Patients complete d the SF-36 Health Survey, an instrument that measures wellness, every 6 mo nths for 2 years. Average annual changes were compared. Results. Fifty-three patients (42 female, 11 male) with asymptomatic, mild (serum calcium level, 10.1-11.5 mg/dL) asymptomatic primary hyperparathyroi dism who agreed to participate were randomized into either a surgical group or an observation group. The mean calcium level was 10.31 mg/dL. The only demographic difference between groups was age, with the operative group bei ng older (66.7 vs 62.6 years,. P < .03). The scores on 2 of the 9 domains o f the SF-36 were significantly different (P < .007 and < .012, respectively ); both favored the operative group. Conclusions. Improved function is seen after parathyroidectomy when compare d with patients who did not undergo operation. This study supports surgical management of mild primary hyperparathyroidism at the time of diagnosis be cause many patients have reversible nonclassic symptoms of the disease.