Correspondence to: Wenjiang Wu (email: 1053660645@qq.com)
Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine
Shenzhen
Guangdong Province
China
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BJS Open, https://doi.org/10.1093/bjsopen/zraf032, published 07 May 2025
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Dear Editor
We read with interest the paper by Matilda et al., which is the first study to examine the quality of life (QoL) of patients with permanent hypoparathyroidism(HP) after total thyroidectomy for benign thyroid disease, using a strict definition of permanent HP and data from more than a decade of follow-up.1The growing interest in individualized prognostic indicators informs clinical decision-making.
Traditional therapy for HP has known limitations, including adverse effects and reduced QoL.2Clinical trials demonstrate that Parathyroid Hormone (PTH) replacement therapy significantly improves QoL.3During the time period of this study, PTH replacement therapy was not widely available, but in 2015 rhPTH(1-84) was approved by the FDA.4The article fails to address why PTH replacement therapy was not used and ignores the possibility that severely affected patients may have lower QoL due to not receiving PTH replacement therapy. Additionally, the permanent HP group was significantly younger. Greater tolerance in younger patients may obscure between-group differences.
A key result of the present study suggests that health-related quality of life (HRQoL) domain scores are comparable between patients with and without permanent HP after total thyroidectomy. Socioeconomic factors such as education level and income status are important confounding variables in HRQoL assessment. A Swedish study confirmed the association of lower socioeconomic status with poorer postoperative HRQoL.5Hence, it is equally crucial to assess the differences in socioeconomic status between the two groups and how this might influence the long-term HRQoL of postoperative patients with HP.
In conclusion, the Matilda et al. challenge the inherent perception that HP inevitably reduces QoL. This will help to alleviate undue concerns of doctors and patients about the long-term QoL impact of postoperative permanent HP and focus individualized treatment. However, additional information on relevant variables might have shed more light on the nature of the problem.
References
Annebäck M, Wachtmeister S, Hedberg J, Stålberg P, Norlén O. Quality of life in patients with permanent hypoparathyroidism after thyroidectomy for benign thyroid disease: population-based study with long-term follow-up. BJS Open, 9. doi: https://doi.org/10.1093/bjsopen/zraf032
Clarke BL, Khan AA, Rubin MR, Schwarz P, Vokes T, Shoback DM, et al. Efficacy and Safety of TransCon PTH in Adults With Hypoparathyroidism: 52-Week Results From the Phase 3 PaTHwa y Trial. The Journal of clinical endocrinology and metabolism, 110, 951–960. doi: https://doi.org/10.1210/clinem/dgae693
Khan AA, Guyatt G, Ali DS, Bilezikian JP, Collins MT, Dandurand K, et al. Management of Hypoparathyroidism. Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research, 37, 2663–2677. doi: https://doi.org/10. 1002/jbmr.4716
Rubin MR, Cusano NE, Fan W-W, Delgado Y, Zhang C, Costa AG, et al. Therapy of Hypoparathyroidism with PTH(1–84): a prospective six Year Investigation of Efficacy and Safety. JClinEndocrinolMetab. 2016;101:2742–50.
Gryth K, Persson C, Näslund I, Sundbom M, Näslund E, Stenberg E. The influence of socioeconomic factors on quality-of-life after laparoscopic gastric bypass surgery. Obes Surg 2019;29: 3569–3576.
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