Parathyroidectomy may reduce type 2 diabetes risk in primary hyperparathyroidism
- 08-12-2025
- Hyperparathyroidism
- News
medwireNews: Primary hyperparathyroidism (pHPT) is associated with an increased risk for multiple cardiometabolic diseases but, of these, only the risk for type 2 diabetes is reduced by parathyroidectomy, suggest data from a large retrospective cohort study.
Nir Tsur and colleagues, from Rabin Medical Center–Beilinson Hospital in Petach Tikva, Israel, say that their findings “highlight both the systemic burden of pHPT and the selective metabolic benefit of surgical intervention” while “underscoring the importance of early recognition and comprehensive management of pHPT.”
The study included data for 50,199 patients (mean age 66 years, 68% women) with pHPT and 150,265 individuals without pHPT who were matched by age, sex, and socioeconomic status.
During up to 15 years of follow-up, the researchers found that, compared with the control group, individuals with pHPT had significantly higher incidences of cardiovascular disease (CVD; 16.1 vs 11.5 cases per 1000 person–years), hypertension (55.3 vs 44.6 cases per 1000 person–years), cerebrovascular accident (19.4 vs 14.1 cases per 1000 person–years), and type 2 diabetes (17.0 vs 12.8 cases per 1000 person–years).
The difference in incidence between the two groups corresponded to people with pHPT having significant 28%, 22%, 22%, and 7% higher risks for CVD, hypertension, cerebrovascular accident, and type 2 diabetes, respectively, after adjustment for potential confounders.
Among the individuals with pHPT, 6654 underwent parathyroidectomy a mean 879 days after diagnosis. These patients had a significantly lower incidence of type 2 diabetes than those who underwent nonsurgical management, at 10.8 versus 15.2 case per 1000 person–years. The adjusted risk reduction in type 2 diabetes associated with parathyroidectomy was a significant 44%.
However, the researchers note that “in contrast to some previous reports,” parathyroidectomy was not associated with reduced risks for CVD, hypertension, or cerebrovascular accident among the participants with pHTP.
“This discrepancy may stem from long-term vascular remodeling caused by chronic hypercalcemia and elevated [parathyroid hormone] levels, which might not fully reverse after surgery, especially given the prolonged time to intervention,” Tsur et al remark.
They continue: “Taken together, these findings reinforce the metabolic benefit of surgery on glycemic outcomes while suggesting that other cardiometabolic risks may persist despite surgical intervention.”
The authors conclude: “Further prospective studies are needed to confirm these observations and to clarify the broader impact of parathyroidectomy on long-term cardiovascular health.”
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