Primary Hyperparathyroidism: Comparing Cardiovascular Morbidity and Mortality in Patients Treated With Parathyroidectomy Versus Conservative Management
Bibliographic record
Abstract
Background: There is emerging evidence suggestive of endothelial and cardiovascular dysfunction in patients with mild or asymptomatic primary hyperparathyroidism (PHPT) although there is a lack of clear consensus regarding potential cardiovascular benefits post elective parathyroidectomy. Methods: We carried out a retrospective observational study on patients with a biochemically confirmed diagnosis of PHPT who were under follow-up at our district general hospital between 1995 and 2016. The primary objective of the study was to compare all-cause mortality in patients who underwent elective parathyroidectomy versus the patients who were managed conservatively. The secondary objective of our study was to compare the rate of development of atherosclerotic cardiovascular disease (ASCVD) in the two groups. Results: Our results showed no statistically significant difference in all-cause mortality rate in the patients managed conservatively as compared to the surgically treated group. However, the rate of ASCVD events, including coronary artery disease and hypertension, were lower in the latter group. Conclusions: The adverse impact of PHPT on the cardiovascular system remains underrecognized with most of the evidence being derived from observational studies supporting a correlation between parathyroid hormone (PTH) levels and ASCVD events. All patients with PHPT should undergo clinical evaluation for ASCVD risks during initial workup as well as during follow-up visits. As elective parathyroidectomy is a relatively safe procedure and ASCVD risk is known to increase with age, there is a rationale to consider surgery for the majority of asymptomatic PHPT patients aged < 60 years. J Endocrinol Metab. 2019;9(4):95-107 doi: https://doi.org/10.14740/jem573
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".