Early parathyroidectomy in mild primary hyperparathyroidism: Effects on heart and bones

Erik Almqvist

Research output: ThesisDoctoral Thesis (compilation)


There is an ongoing controversy regarding how to take care of patients with mild primary hyperparathyroidism (PHPT). Some recommend surgical treatment at diagnosis, others just follow-up as long as there is no evidence of disease progression. The aim of this thesis was to evaluate cardiac and skeletal risk factors related to the duration of mild PHPT.

Fifty patients with mild PHPT were randomized to parathyroidectomy (PTX) either at diagnosis or 1 year later. The skeleton was examined using dual-energy X-ray absorptiometry and biochemical markers. Echocardiography, equilibrium radionuclide angiography (ERNA) and plasma NT-proBNP were used to evaluate cardiac structure and function.

Whereas bone mineral density (BMD) in the lumbar spine increased equally after PTX in both groups of patients, the group with an extra year of exposure to mild PHPT showed impaired ability to regain BMD in the hip. Surprisingly, the most important determinant of the increase in BMD after PTX in postmenopausal women was not the normalized serum level of parathyroid hormone or calcium, but a concomitant increase in circulating bioavailable testosterone.

At baseline, myocardial hypertrophy (a strong risk factor of premature death) was correlated to the serum concentration of parathyroid hormone but not to the level of serum calcium. At the end of the study, the patients who had delayed PTX showed significant increase of left ventricular hypertrophy, in contrast to the group treated immediately. After PTX, a transient dip occurred in heart function parameters measured by ERNA. This dip was subclinical and had no influence on exercise capacity. Abnormal cardiac secretion of NT-proBNP substantiated the observations made by ERNA.

In conclusion, these results obtained by a prospective and randomized study design, show that early PTX has favourable effects on heart and bones in patients with mild PHPT. Thus, PHPT should be treated surgically without delay irrespective of serum calcium level.
Original languageEnglish
Awarding Institution
  • Surgery
  • Bondeson, Anne-Greth, Supervisor
Award date2006 Oct 12
ISBN (Print)91-85559-34-2
Publication statusPublished - 2006

Bibliographical note

Defence details

Date: 2006-10-12
Time: 14:00
Place: Föreläsningssalen, Kirurgiska kliniken, Universitetsjukhuset MAS, Malmö

External reviewer(s)

Name: Smeds, Staffan
Title: Professor
Affiliation: Sergelkliniken, Linköping


<div class="article_info">Erik Almqvist, Charlotte Becker, Anne-Greth Bondeson, Lennart Bondeson and Johan Svensson. <span class="article_issue_date">2004</span>. <span class="article_title">Early parathyroidectomy increases bone mineral density in patients with mild primary hyperparathyroidism. A prospective and randomized study.</span> <span class="journal_series_title">Surgery</span>, <span class="journal_volume">vol 136</span> <span class="journal_pages">pp 1281-1288</span>. <span class="journal_distributor">Elesevier Inc.</span></div>
<div class="article_info">Erik Almqvist, Charlotte Becker, Anne-Greth Bondeson, Lennart Bondeson and Johan Svensson. <span class="article_issue_date">2006</span>. <span class="article_title">Increase of bioavailable testosterone is associated with gain in bone mineral density after cure of primary hyperparathyroidism in postmenopausal women.</span> <span class="journal_series_title">Clinical Endocrinology</span>, <span class="journal_volume">vol 64</span> <span class="journal_pages">pp 58-62</span>. <span class="journal_distributor">Blackwell Publishing Ltd</span></div>
<div class="article_info">Erik Almqvist, Anne-Greth Bondeson, Lennart Bondeson, Anders Nissborg, Peter Smedgård and Sven-Eric Svensson. <span class="article_issue_date">2002</span>. <span class="article_title">Cardiac dysfunction in mild primary hyperparathyroidism assessed by radionuclide angiography and echocardiography before and after parathyroidectomy.</span> <span class="journal_series_title">Surgery</span>, <span class="journal_volume">vol 132</span> <span class="journal_pages">pp 1126-1132</span>. <span class="journal_distributor">Mosby Inc,</span></div>
<div class="article_info">Erik Almqvist, Charlotte Becker, Anne-Greth Bondeson, Lennart Bondeson, Johan Svensson and Sven-Eric Svensson. <span class="article_issue_date">2006</span>. <span class="article_title">Increased plasma concentrations of N-terminal pro-B-type natriuretic peptide in patients with mild primary hyperparathyroidism.</span> <span class="journal_series_title">Clinical Endocrinology</span>, <span class="journal_distributor">Blackwell Publishing Ltd</span> (inpress)</div>

Subject classification (UKÄ)

  • Surgery


  • parathyroidectomy
  • hyperparathyroidism
  • bone metabolism
  • testosterone
  • myocardial hypertrophy
  • cardiac function
  • echocardiography
  • radionuclide angiography
  • natriuretic peptide
  • Surgery
  • orthopaedics
  • traumatologi
  • ortopedi
  • traumatology
  • Kirurgi


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