Evaluation of the Pasieka quality of life questionnaire results in operated primary hyperparathyroidism patients

Objective: To evaluate preoperative and postoperative symptomatic improvement in patients operated for primary hyperparathyroidism (PHPT) using the Pasieka Quality of Life Questionnaire, and to assess the outcomes. Materials and Methods: This retrospective study included patients who underwent surgery for primary hyperparathyroidism at the Department of General Surgery, Division of Breast and Endocrine Surgery, Akdeniz University Hospital, between January 2022 and June 2024, and who completed the Pasieka Quality of Life Questionnaire both preoperatively and postoperatively. Patients were followed up until June 2025. Questionnaire results were analyzed to assess symptomatic improvement and differences between groups. Results: Of the 204 patients included, 46 (22.5%) were male and 158 (77.5%) were female. Patients were grouped as 18–40 years (n=21, 10.3%), 41–65 years (n=145, 71.1%), and ≥66 years (n=38, 18.6%), with a mean age of 53.6 years. Among all surgical indications, 172 patients had isolated PHPT (7 with intrathyroidal adenoma), and 32 patients had PHPT with concomitant thyroid disease (3 PHPT with Hashimoto's thyroiditis, 17 PHPT with thyroid malignancy, 11 PHPT with multinodular goiter, and 1 PHPT with toxic diffuse goiter). Concomitant thyroidectomy was performed in these cases. A total of 147 (72.05%) patients underwent single adenoma excision, 20 (9.8%) multigland excision, 24 (11.76%) single adenoma excision and hemithyroidectomy, and 13 (6.37%) single adenoma excision and total thyroidectomy. Histopathological examination revealed parathyroid hyperplasia in 13.1% of patients. Postoperative pathology and surgical notes showed single adenoma in 184 (90.19%) and multigland adenoma in 20 (9.8%) patients. Comorbidities were absent in 53 (23%) patients, while 29 (14.2%) had hypertension, 18 (8.8%) type 2 diabetes mellitus, and 35 (17.2%) both hypertension and diabetes. Preoperative scintigraphy localized the parathyroid adenoma to the right upper gland in 15 (7.4%), right lower in 71 (34.8%), left upper in 17 (8.3%), left lower in 62 (30.4%), multigland in 10 (4.9%), and was non-localized in 29 (14.2%) cases. Intraoperative findings confirmed adenoma localization in the right upper gland in 20 (9.8%), right lower in 75 (36.76%), left upper in 21 (8.82%), left lower in 68 (33.3%), and multigland adenoma in 20 (9.8%) patients. The positive predictive value of ultrasonography and scintigraphy was 91.4%, and the sensitivity was 84.7%. Based on preoperative DEXA T and Z scores, 122 (59.8%) patients were normal, 74 (36.3%) had osteopenia, and 8 (3.9%) had osteoporosis; no patients had severe osteoporosis. Preoperative corrected calcium levels ranged from 9.16 to 15.02 mg/dL (median 11.05 ± 0.81 mg/dL). Preoperative PTH values ranged from 51 to 683 pg/mL (median 136 ± 106 pg/mL). Vitamin D ranged from 3 to 75 ng/mL (median 22 ± 13.15 ng/mL), albumin from 22.8 to 55 g/dL (median 48 ± 3.92 g/dL), and alkaline phosphatase from 30 to 251 IU/L preoperatively (median 93 ± 40.43 IU/L) and 32 to 467 IU/L postoperatively at 6 months (median 75 ± 41.75 IU/L). Preoperative creatinine ranged from 0.42 to 1.7 mg/dL (median 0.71 ± 0.19 mg/dL), and GFR from 31 to 141 (median 98 ± 18.25), with no significant postoperative changes. Twenty-four-hour urinary calcium excretion ranged from 70 to 1147 mg/day (median 325 ± 159.4 mg/day). Analysis of responses to the 13-item Pasieka Quality of Life Questionnaire showed a postoperative decrease in scores for all symptoms compared to preoperative levels. The most pronounced symptomatic improvement occurred within the first postoperative month, and significant improvement persisted at one year. Conclusion: Although primary hyperparathyroidism often presents symptomatically, advances in laboratory testing have facilitated earlier diagnosis and treatment. In this study, postoperative symptomatic improvement was observed in all patients. The Pasieka Quality of Life Questionnaire may be a useful tool for evaluating postoperative symptomatic recovery in patients operated for primary hyperparathyroidism. Keywords: Primary Hyperparathyroidism, Pasieka, Symptom, Recovery, Quality of Life