Older patients benefit from parathyroid surgery
Am I too old to have surgery?
All patients with primary hyperparathyroidism should be considered for surgery regardless of age. Primary hyperparathyroidism is most common in patients in their 60's or younger, but it can occur in patients in their 70's, 80's and even 90's. Unfortunately, many elderly are missing an opportunity to be cured of primary hyperparathyroidism with a low-risk operation. A recent population-based study of patients with primary hyperparathyroidism demonstrated patients who were 60 to 69 years of age were about 23 times less likely to have parathyroid surgery compared to patients less than 50. Patients over 80 years old were 89 times less likely to undergo parathyroid surgery compared to patients less than 50. Those elderly patients that do undergo parathyroid surgery often have a significant delay in the time from diagnosis to surgery. 50, 70, 71 However, based on a number of studies, it appears that patients over 70 who have parathyroid surgery typically have excellent results with cure rates similar to that of younger patients. 49, 50, 72-78 In addition, elderly patients who have had a successful parathyroidectomy live their remaining years with fewer symptoms, which in turn can lead to a better quality of life. 49, 50, 74, 79 Problems like fractures (especially of the hip), worsening mental function, and muscle weakness contribute significantly to worsening quality of life and the chance of hospitalization and dying in the elderly. Primary hyperparathyroidism can make these conditions worse or more likely to happen. Parathyroidectomy may improve bone strength and everyday functioning for elderly patients. A number of studies have shown that parathyroidectomy is safe for elderly patients. The chance of having a complication in the elderly appears to be roughly equivalent to that of younger patients. Although many elderly patients have associated illnesses such as heart disease, high blood pressure, and diabetes, most studies have shown that the elderly do not have a higher rate of complications in organs outside of the surgical site, such as heart, lung, or kidney. Many studies have shown that patients older than 70 seem to be at no higher risk of dying from parathyroid surgery than in the younger population. 49, 50, 72, 74, 75, 78, 80 There is also support now for outpatient minimally invasive parathyroid surgery in the elderly, as it has been shown that it can be done safely, and the majority of elderly patients can go home on the same day of surgery, without any increased risk compared to the younger patients. 76, 77, 80, 81 Each patient has a unique medical history that helps determine the balance between the risks and benefits of an operation. Elderly patients with primary hyperparathyroidism should discuss whether or not an operation is appropriate with their team of doctors.