ImportancePrimary hyperparathyroidism (PHPT) is a common endocrine disorder associated with neuropsychiatric symptoms. Although parathyroidectomy has been associated with improvement of preexisting depression among adults with PHPT, the effect of parathyroidectomy on the development of new depression is unknown.ObjectiveTo determine the effect of early parathyroidectomy on the incidence of new depression among adults with PHPT compared with nonoperative management.Design, Setting, and ParticipantsAnalyzed data included observational national Veterans Affairs data from adults with a new diagnosis of PHPT from 2000 through 2019 using target trial emulation with cloning, a biostatistical method that uses observational data to emulate a randomized clinical trial. New depression rates were compared between those treated with early parathyroidectomy vs nonoperative management using an extended Cox model with time-varying inverse probability censoring weighting, adjusted for patient demographics, comorbidities, and depression risk factors. Eligible adults with a new biochemical diagnosis of PHPT, excluding those with past depression diagnoses, residing in an assisted living/nursing facility, or with Charlson Comorbidity Index score higher than 4 were included. These data were analyzed January 4, 2023, through June 15, 2023.ExposureEarly parathyroidectomy (within 1 year of PHPT diagnosis) vs nonoperative management.Main OutcomeNew depression, including among subgroups according to patient age (65 years or older; younger than 65 years) and baseline serum calcium (11.3 mg/dL or higher; less than 11.3 mg/dL).ResultsThe study team identified 40 231 adults with PHPT and no history of depression of whom 35896 were male (89%) and the mean (SD) age was 67 (11.3) years. A total of 3294 patients underwent early parathyroidectomy (8.2%). The weighted cumulative incidence of depression was 11% at 5 years and 18% at 10 years among patients who underwent parathyroidectomy, compared with 9% and 18%, respectively, among nonoperative patients. Those treated with early parathyroidectomy experienced no difference in the adjusted rate of new depression compared with nonoperative management (hazard ratio, 1.05; 95% CI, 0.94-1.17). There was also no estimated effect of early parathyroidectomy on new depression in subgroup analyses based on patient age or serum calcium.ConclusionsIn this study, there was no difference in the incidence of new depression among adults with PHPT treated with early parathyroidectomy vs nonoperative management, which is relevant to preoperative discussions about the benefits and risks of operative treatment.

中文翻译：

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甲状旁腺切除术和原发性甲状旁腺功能亢进症成人新抑郁症的发展


重要性原发性甲状旁腺功能亢进症 （PHPT） 是一种常见的与神经精神症状相关的内分泌疾病。尽管甲状旁腺切除术与 PHPT 成人患者先前存在的抑郁症的改善有关，但甲状旁腺切除术对新发抑郁症发展的影响尚不清楚。目的确定与非手术治疗相比，早期甲状旁腺切除术对 PHPT 成人新发抑郁发生率的影响。设计、设置和参与者分析的数据包括 2000 年至 2019 年新诊断为 PHPT 的成年人的全国退伍军人事务观察数据，使用带有克隆的目标试验模拟，这是一种使用观察数据模拟随机临床试验的生物统计方法。使用具有时变逆概率删失加权的扩展 Cox 模型比较早期甲状旁腺切除术与非手术治疗之间的新抑郁发生率，并根据患者人口统计学、合并症和抑郁危险因素进行调整。纳入了新生化诊断为 PHPT 的符合条件的成年人，不包括既往有抑郁症诊断、居住在辅助生活/护理机构或查尔森合并症指数评分高于 4 的患者。这些数据于 2023 年 1 月 4 日至 2023 年 6 月 15 日进行了分析。主要结局新发抑郁，包括根据患者年龄 （65 岁或以上;小于 65 岁） 和基线血清钙 （11.3 mg/dL 或更高;低于 11.3 mg/dL） 的亚组。结果研究小组确定了 40 231 例成人 PHPT 患者，无抑郁病史，其中 35896 例为男性 （89%），平均 （SD） 年龄为 67 （11.3） 岁。 共有 3294 例患者接受了早期甲状旁腺切除术 （8.2%）。接受甲状旁腺切除术的患者 5 年和 10 年抑郁症的加权累积发生率分别为 11% 和 18%，而非手术患者分别为 9% 和 18%。与非手术治疗相比，接受早期甲状旁腺切除术治疗的患者新发抑郁的调整发生率没有差异 （风险比，1.05;95% CI，0.94-1.17）。在基于患者年龄或血清钙的亚组分析中，也没有估计早期甲状旁腺切除术对新发抑郁的影响。结论在本研究中，接受早期甲状旁腺切除术治疗与非手术治疗的 PHPT 成人患者新发抑郁的发生率没有差异，这与术前关于手术治疗的益处和风险的讨论有关。