Parathyroidectomy lowers risk of diabetes in patients with primary hyperparathyroidism

For patients with primary hyperparathyroidism, parathyroidectomy may help prevent the development of diabetes, as reported in a study.

Researchers used a territory-wide electronic health database in Hong Kong and identified 3,135 patients (mean age 67.5 years, 70.5 percent female) with primary hyperparathyroidism. Of these, 596 (19 percent) underwent subsequent parathyroidectomy (surgical group) and 2,539 (81.0 percent) did not (control group).

The primary outcome of diabetes occurred in 156 patients in the surgical group over a median follow-up of 5.5 years and in 518 patients in the control group over a median follow-up of 2.2 years.

Parathyroidectomy was associated with a 32-percent reduction in the risk of incident diabetes (hazard ratio [HR], 0.68, 95 percent confidence interval [CI], 0.65–0.71; p<0.001). This protective association persisted across multiple sensitivity analyses.

Subgroup analyses indicated that the diabetes risk reduction associated with parathyroidectomy was pronounced for younger patients (age ≤65 years: HR, 0.64, 95 percent CI, 0.60–0.68; age >65 years: HR, 0.68, 95 percent CI, 0.63–0.72; p<0.001 for interaction) and for those with more severe primary hyperparathyroidism as defined by parathyroid hormone (greater than twice the upper limit of normal: HR, 0.58, 95 percent CI, 0.53–0.63; not more than twice the upper limit of normal: HR, 0.73, 95 percent CI, 0.69–0.77) and calcium levels (>2.8 mmol/L: HR, 0.58, 95 percent CI, 0.54–0.63; ≤2.8 mmol/L: HR, 0.69, 95 percent CI, 0.66–0.73; p<0.001 for interaction).

The findings suggest that parathyroidectomy has potential additional metabolic benefits in primary hyperparathyroidism.