Early parathyroidectomy does not mitigate depression risk in primary hyperparathyroidism

Among adults with primary hyperparathyroidism (PHPT), the incidence of new depression after early parathyroidectomy does not appear to be different than that after nonoperative management, as shown in a study.

Researchers used observational national Veterans Affairs data and included adults with a new diagnosis of PHPT. A target trial emulation with cloning was used to examine the incidence of new-onset depression after treatment with early parathyroidectomy (within 1 year of PHPT diagnosis) vs after nonoperative management. New depression was evaluated in subgroups defined by patient age (≥65 and <65 years) and baseline serum calcium (≥11.3 and <11.3 mg/dL).

The analysis included 40,231 adults (mean age 67 years, 89 percent male) with PHPT and no history of depression. Early parathyroidectomy was performed in 3,294 patients (8.2 percent).

The weighted cumulative incidence of depression was 11 percent at 5 years and 18 percent at 10 years in the parathyroidectomy group as compared with 9 percent and 18 percent, respectively, in the nonoperative group.

Early parathyroidectomy was not associated with an increased risk of new-onset depression compared with nonoperative management (hazard ratio, 1.05, 95 percent CI, 0.94–1.17). This held true in subgroup analyses based on patient age or baseline serum calcium levels.

The findings may prove valuable in the context of preoperative discussions about the benefits and risks of operative treatment.