Mental Health Affected in Patients With Hypoparathyroidism After Surgery, Study Suggests

People with hypoparathyroidism, particularly if they developed the condition after surgery, experience worse patient-reported mental health than healthy individuals, a study reports.

The study, “The effects of patient and disease-related factors on the quality of life in patients with hypoparathyroidism,” was published in the journal Archives of Osteoporosis.

People with primary hypoparathyroidism may experience muscle cramping, seizures, irritability, and bradycardia (slower heart rate) due to low calcium levels, all of which can reduce quality of life. Previous studies have reported that hypoparathyroidism patients had physical, emotional, and mental complaints despite being properly treated.

The most common cause of hypoparathyroidism is damage to the parathyroid glands — responsible for producing parathyroid hormone (PTH) — after neck surgery, a condition called post-surgical hypoparathyroidism. In a minority of cases, the disorder arises due to an autoimmune reaction or a genetic defect that halts the development of the parathyroid glands. In such cases, the condition is called non-surgical hypoparathyroidism.

In the study, researchers from Turkey conducted a survey to assess which factors affect quality of life in people with hypoparathyroidism.

The study enrolled 160 patients with chronic hypoparathyroidism (88.1% women, mean age 47.2), 127 patients with post-surgical disease, and 33 with non-surgical hypoparathyroidism. The patients were admitted to hospital between December 2017 and June 2019. Median disease duration was seven years. Forty-six patients (36.2%) with post-surgical hypoparathyroidism had thyroid cancer. A group of 148 healthy individuals served as controls.

The team used a well-established tool for health‐related quality of life — the 36‐Item Short Form Health Survey — which assesses physical functioning, role of physical functioning, bodily pain, general health perceptions, vitality, social functioning, role of emotional functioning, and mental health. Each topic is scored from one to six, with total scoring ranging from zero to 100. Higher scores correspond to better health-related quality of life.

Symptoms of low calcium levels, or hypocalcemia, were more common among participants with post-surgical hypoparathyroidism (54.3%) than in those with non-surgical disease (45.5%).

Intravenous (into-the-vein) emergency administration of calcium in the last six months was performed in 13.4% of post-surgical patients and 18.2% of the non-surgical participants.

Oral calcium replacement was given to nearly all patients (95.5%), and calcitriol, the active form of vitamin D, was given to 96.3%.

Hypothyroidism was seen in all post-surgical cases and in 15.2% of non-surgical patients.

As expected, patients had lower levels of calcium, magnesium, and PTH than controls, and higher levels of phosphorus, alkaline phosphatase, and creatinine — a kidney damage marker. They also showed lower levels of thyroid-stimulating hormone but higher levels of free thyroxine (fTH4) than healthy volunteers.

No significant differences were found for most laboratory parameters between post-surgical and non-surgical hypothyroidism groups, but PTH and fT4 levels were higher in post-surgical patients than in non-surgical participants.

The survey results showed that people with hypoparathyroidism scored lower in all eight measures compared to controls. Notably, the non-surgical group had significantly better scores in vitality and mental health domains than post-surgical cases.

By comparing patients whose calcium levels were within a predefined range, the scientists found significant differences in mental health scores between post-surgical and non-surgical hypoparathyroidism. Within the interval of 8 to 8.4 mg/deciliter (dL), the mental health score was 70 in the non-surgical group compared to 56 in the post-surgical group; in the 8.5 to 8.9 mg/dL range, the non-surgical group scored 80 and the post-surgical group scored 60. No differences were observed for higher or lower calcium levels.

Having an additional chronic disease had a negative impact on quality of life, leading to worse physical function and general health perceptions. Older age was also associated with lower physical functioning in all respondents. Non-surgical patients with longer disease duration had better scores in vitality and mental health than post-surgical patients.

Subsequent analyses found that sex and cause of hypoparathyroidism influenced mental health scores. In addition, age, sex, and disease duration were predictors of physical functioning, while higher phosphorous level was a predictor of greater bodily pain and worse social functioning.

Overall, the findings suggest that “while [quality of life] is reduced in both post-surgical and non-surgical [hypoparathyroidism] groups, mental health seems to be less affected in non-surgical patients,” the researchers wrote.

“Non-surgical patients might be tolerating hypocalcemia symptoms, lower calcium levels, and longer disease duration better than post-surgical ones,” they concluded.