Quality of Life Following Parathyroidectomy for Primary Hyperparathyroidism: Symptom Resolution Kinetics

OBJECTIVE: Primary hyperparathyroidism has been associated with significant symptom burden and impaired quality of life (QoL), yet the trajectory of recovery, especially in reoperative patients is incompletely characterised. This study evaluated longitudinal QoL changes following parathyroidectomy, characterising symptom resolution kinetics and comparing outcomes between cohorts. A prospective longitudinal cohort study was conducted between July 2021 and September 2023 at a single high volume tertiary centre. Patients with biochemically confirmed primary hyperparathyroidism who underwent parathyroidectomy were selected to complete the Primary Hyperparathyroidism Quality of Life questionnaire preoperatively, at 2 weeks postoperatively and then monthly through 12 months postoperative. RESULTS: There were 124 patients who completed at least one survey. Mean QoL scores improved significantly from baseline (31) to Month 1 (42; Cohen's d = 0.92). Symptom resolution generally occurred in over half of patients, with fatigue and bone pain resolving in 88% and 85% of patients by Month 12 respectively. Neuropsychiatric symptoms had a more variable postoperative resolution. Lower baseline QoL was the only predictor in postoperative QoL score improvement (β = -0.51, p < 0.01). Reoperative parathyroidectomy was associated with similar QoL improvements but higher rates of persistent neurocognitive symptoms. CONCLUSION: Parathyroidectomy results in both rapid and persistent improvement in QoL in patients with primary hyperparathyroidism. Symptom resolution was variable based on number of operations and symptom domain. Baseline QoL was the strongest predictor of benefit supporting the use of QoL as a preoperative metric to be considered in patients with primary hyperparathyroidism.