Parathyroidectomy and risk of neuropsychiatric disorders in primary hyperparathyroidism: A nationwide retrospective cohort study

초록

Background: Primary hyperparathyroidism (PHPT) is associated with neuropsychiatric symptoms, including cognitive impairment and mood disturbances, but population-level evidence on the impact of parathyroidectomy remains limited. Objective: To evaluate the association between parathyroidectomy and incident neuropsychiatric disorders in PHPT. Methods: We conducted a nationwide retrospective cohort study using the Korean National Health Insurance Service database (2003–2022). Adults aged ≥20 years with PHPT were included. Two populations were analyzed: population A (E21.0) and population B (E21.0 or E21.3). Patients were classified by parathyroidectomy status. Outcomes included mild cognitive impairment, dementia, delirium, composite cognitive impairment, psychotic disorder, anxiety, bipolar disorder, depression, and sleep disorders. Cox proportional hazards models adjusted for age and sex were used. Results: A total of 7,427 patients in population A and 19,852 in population B were analyzed, with a median follow-up of approximately 4.8–5.8 years. Parathyroidectomy was associated with a reduced risk of dementia (HR 0.719–0.711) and composite cognitive impairment (HR 0.840–0.823) across both populations. Delirium risk was also reduced in population B (HR 0.382). Bipolar disorder risk appeared lower (HR 0.567–0.578); however, the number of incident cases was small, limiting interpretability. Anxiety risk showed a modest increase in population B (HR 1.135), while depression and sleep disorders were not significantly associated. Conclusion: Parathyroidectomy was associated with reduced risks of cognitive outcomes in PHPT. These findings may reflect biological effects of surgery, including normalization of calcium homeostasis and related neurocognitive pathways.