Hyperparathyroidism in patients over 80: clinical characteristics and their ability to undergo outpatient parathyroidectomy.

OBJECTIVE: Parathyroid surgery in elderly patients is commonly delayed due to perceived high operative risk. We evaluated the presentation of patients over 80 with primary hyperparathyroidism (PHPT) and their ability to tolerate outpatient, minimally invasive parathyroidectomy.

METHODS: We conducted a prospective cohort study of 150 consecutive patients over the age of 80 for the treatment of sporadic, nonfamilial PHPT. Presenting symptoms were compiled by questionnaire and compared between male and female (32 males, 118 females) and to 2600 patients under the age of 80. All patients underwent minimally invasive parathyroidectomy and were discharged from the recovery room. Operative findings and outcomes were assessed.

RESULTS: 97% reported at least one symptom--the majority had five or more. The most common symptoms were fatigue, hypertension, and memory problems (occurring in 62%, 62%, and 57% of patients, respectively). Symptoms were similar between men and women, with the exception of bone pain being twice as common in women and kidney stones being twice as common in men (both p < 0.05). Preoperative calcium and parathyroid hormone (PTH) levels as well as the frequency of each symptom closely paralleled those of patients less than 80 years old with no significant differences. Average operative time was 18 +/- 5 minutes with discharge averaging 1.9 +/- 0.2 hours later. The incidence of single adenoma, double adenoma, or hyperplasia was identical to patients less than 80 (p = NS). Two patients required rehospitalization within 30 days of the procedure (congestive heart failure and pulmonary embolism), neither one for hypocalcemia. There were no deaths, and the cure rate was 99.3%.

CONCLUSION: PHPT is similar symptomatically, biochemically, and histopathologically between patients > 80 years old and younger patients. Modern techniques allow for small incisions, quick operative times, outpatient discharge, and uneventful recovery. Patients over 80 years old tolerate outpatient parathyroidectomy without event.