Estudio de la calidad de vida, estado de ánimo y calidad de sueño en el hiperparatiroidismo primario esporádico

Resumo

INTRODUCTION. The clinical presentation of primary hyperparathyroidism (PHPT) has changed in recent years. Most patients are now diagnosed through laboratory tests, at a time when the disease is asymptomatic or with non-specific symptoms. However, these patients are associated with manifestations that may impair aspects of quality of life and other spheres of general well-being. In addition, some socio-personal and clinical variables may influence this impairment. The aim of this study was to determine the impact on quality of life, mood and sleep quality in patients with PTH, and to analyze the changes in these parameters in the medium and long term after surgery. The analysis of a socio-personal and clinical profile that may influence the improvement of quality of life after parathyroidectomy has also been determined. PATIENTS AND METHODS. Patients diagnosed with sporadic PHPT were included, as well as a control group of healthy persons matched for age and sex. Quality of life was analyzed using the SF-36 questionnaire and the specific PHPQoL questionnaire, mood with the Beck questionnaire and sleep quality with the Pittsburg questionnaire. All patients underwent parathyroidectomy and comparisons were made with the results obtained 3 and 12 months after surgery. Socio-personal and clinical variables were analyzed. Statistical analysis: SPSS v.28.0, Student's t test / ANOVA test / χ2 test / Pearson correlation coefficient / effect size (G*Power). A binary logistic regression model of quality of life was estimated for the determination of the socio-personal and clinical improvement profile. RESULTS. Forty-nine patients with PHPT were analyzed. A greater negative effect on quality of life, mood and sleep quality was observed compared to the control group (p < 0.05), with a good correlation between questionnaires. Three months after surgery, the summary of physical and mental components improved significantly (p = 0.024; p = 0.007), maintaining in the latter the improvement one year after surgery (p = 0.003) and showing no differences with the control group (p = 0.122). The change in the declared evaluation of health at 12 months was the parameter with the largest effect size (d = 0.789). The PHPQoL questionnaire showed a progression in quality of life from 3 months (p < 0.001), with an added improvement at 1 year after surgery (p < 0.001). Long-term postoperative scores in the domain of mood and sleep quality were significantly better (p < 0.001; p = 0.032). Osteoporosis and/or bone pain, patients with a history of depression and/or anxiety, and preoperative and postoperative PTH levels influence the probability of improvement in quality of life (p < 0.05). CONCLUSIONS. Patients with PTH have a poorer assessment of quality of life in all spheres, together with an impairment of mood and sleep quality, compared to the general population. There is an improvement after parathyroidectomy, which is maintained one year after surgery. Aspects such as osteoporosis, a history of depression and/or anxiety, or PTH levels can influence the improvement in postoperative quality of life. It is recommended that quality of life and mood disorders be assessed in the clinical evaluation of these patients in order to offer a more individualized treatment.