Abstract
BackgroundPrimary hyperparathyroidism (PHPT) is often accompanied by neuropsychiatric symptoms. This study aimed to map out psychiatric comorbidity as reflected by medical treatment for psychiatric symptoms.MethodsA retrospective case–control analysis and a prospective cohort analysis of psychotropic drug utilization before and after PTX. A total of 8279 PHPT patients treated with parathyroidectomy in Sweden between July 1, 2008 and December 31, 2017 compared to a matched control cohort from the total population (n = 82,790). Information on filled prescriptions was collected from the Swedish Prescribed Drug Register (SDR). Socioeconomic data and diagnoses were added by linkage to national patient and population registers. Regression analyses were used to calculate relative drug utilization (OR) within 3 years prior to PTX and relative incidence of drug treatment (RR) within 3 years postoperatively.ResultsUtilization of antidepressant, anxiolytic and sleep medication was more comprehensive in PHPT patients compared with the controls prior to PTX. The most common were benzodiazepines [OR 1.40 (95% CI: 1.31–1.50)] and selective serotonin reuptake inhibitors [SSRI; OR 1.38 (95% CI: 1.30–1.47)]. Postoperatively, the excess prescription rate for anxiolytic benzodiazepines decreased within three years from a 30 to 19% excess and for benzodiazepines for sleep from 31 to 14%. No corresponding decrease in excess prescription rate was observed for SSRI.ConclusionPHPT is associated with increased utilization of antidepressive medications and benzodiazepines before PTX. This study implies that psychiatric symptoms should be considered in PHPT patients and continuous medication should be reevaluated after PTX.
Highlights
Today, primary hyperparathyroidism (PHPT) is a common disease that ranks third among endocrine diagnoses [1]
A total of 8279 PHPT patients treated with parathyroidectomy in Sweden between July 1, 2008 and December 31, 2017 compared to a matched control cohort from the total population (n = 82,790)
The retrospective analysis revealed that the utilization of psychotropic drugs was more extensive in patients prior to PTX than in the average population within 3 years prior to PTX (Table 3)
Summary
Primary hyperparathyroidism (PHPT) is a common disease that ranks third among endocrine diagnoses [1]. Significant neuropsychiatric symptoms, namely depression, anxiety, cognitive decline, fatigue and sleep disorders may be present even in a biochemically mild disease where an indisputable indication for surgical treatment is lacking. Though the occurrence of neuropsychiatric symptoms related to PHPT is not controversial today, the clinical significance and the pathophysiology is debated [2, 9–12]. Primary hyperparathyroidism (PHPT) is often accompanied by neuropsychiatric symptoms. Results Utilization of antidepressant, anxiolytic and sleep medication was more comprehensive in PHPT patients compared with the controls prior to PTX. Conclusion PHPT is associated with increased utilization of antidepressive medications and benzodiazepines before PTX.
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