New thesis on Primary Hyperparathyroidism, PHPT
Anna Koman at the research group Endocrine Surgery, the Department of Molecular Medicine and Surgery, will defend her thesis "Primary hyperparathyroidism: nonclassical symptoms and benefits of parathyroidectomy" on October 15th, 2021. Main Supervisor is Inga-Lena Nilsson.
What's the main focus of your thesis?
Primary hyperparathyroidism (PHPT) is usually caused by a benign parathyroid tumor that results in impaired calcium metabolism and elevated blood calcium levels. The only curative treatment is parathyroidectomy (PTX) which is recommended at age <50 years or development of complications, e.g. osteoporosis or kidney stones. However, PHPT is often associated with impaired quality of life due to non-specific symptoms in the form of depression, decreased strength and muscle weakness that can also be due to other causes or aging. Predicting the benefits of parathyroidectomy regarding cognition, mental health and musculoskeletal symptoms is therefore a diagnostic dilemma.
This dissertation aims to explore non-disease-specific symptoms, their impact on health in order to improve the management and treatment of patients with PHPT who do not have a mandatory indication for curative surgery.
Which are the most important results?
In Study I, we found that during normalization of calcium levels medically for four weeks preoperatively, improvement in cognition, mental health and muscle strength was achieved which correlated well with the postoperative improvements 6 months after surgery (positive predictive values 74 - 96%). We therefore suggest that calcimimetics are a useful prognostic tool for predicting the effects after parathyroidectomy.
Study II is a sub-analysis of 36 patients> 50 years with mild cognitive impairment from Study I. We found that half of the patients achieved normal cognitive function 6 months postoperatively and that the prognostic method worked well in this group as well.
Study III is a population study comparing the use of antidepressants, anti-anxiety drugs and sleeping pills before and after curative surgery. The two-part study, a retrospective case-control study and a forward-looking cohort study, showed that use of drugs was significantly more extensive in patients with a declining trend over three years after surgery. However, the medication remained elevated in patients compared to the background cohort.
In Study IV, the utilization of dental care and the incidence of tooth extractions in PHPT patients were analyzed compared with a cohort from the background population. Overall, we found no major differences except that the risk of tooth extraction was significantly increased (Incidence Rate Ratio 1.8) in patients with moderately to severely elevated calcium levels preoperatively.
How can this new knowledge contribute to the improvement of people's health?
PHPT is a common diagnosis with a prevalence of about 1 percent in the population. A few patients are subject to surgical treatment and the majority are often considered asymptomatic and treated conservatively despite the fact that significant non-specific symptoms sometimes occur. Our aim has been to increase the knowledge about non-disease-specific symptoms of PHPT in order to help provide each patient with fair treatment, with the right indication and right expectations.
What are your future ambitions?
Our intention is to clinically implement and further evaluate the diagnostic method described in Study I and II. Furthermore, we intend to develop and expand Study III and IV with continued epidemiological analyzes of e.g. geographical variations, pain medication and possible connections with dental health to increase knowledge about comorbidity related to PHPT.