Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder with increasing prevalence, but the majority of cases (over 85%) are now perceived to be mild and remain untreated. Objectives: The main focus of this thesis is to provide an accurate update of the epidemiology of PHPT based on population data, and to investigate its long-term outcomes in the mild subgroup compared with those with severe disease. Design: A large retrospective cohort study using routinely collected data in Tayside, Scotland, 1997-2006. Results: The prevalence of PHPT is increasing annually during the study period with an unexpected cyclic incidence. Although most of the patients do not progress in the long-term, patients with mild untreated PHPT have an increased risk of mortality and of developing co-morbidities; the risks are similar in those with a severe PHPT condition. Parathyroid hormone predicts both disease progression and associated adverse outcomes in untreated patients. Parathyroidectomy normalises calcium and parathyroid hormone, as well as reducing the risks of adverse outcomes. Conclusions: Based on the study findings, this thesis concludes that although PHPT has become a mild stable condition, the increased risk associated with untreated PHPT should not be neglected and requires vigorous management to avoid a future heath burden. Large randomised controlled trials are needed to evaluate the surgical outcomes in comparison to the cost-effectiveness of alternative treatments.
|Date of Award||2011|
|Supervisor||Peter Donnan (Supervisor) & Graham Leeese (Supervisor)|