Am I Too Old to Have Parathyroid Surgery?

Hi, Michael Yeh here from UCLA Health Endocrine Surgery, here to answer the question:

Am I too old to have parathyroid surgery?

The short answer is—almost certainly not. Think of parathyroid surgery as an investment in your future bone health. The main reason we perform this operation is that it's well established to increase bone mineral density over a period of two to five years. That translates into a reduced rate of major fractures for the next decade after surgery.

As with any health procedure, there’s a small immediate risk, and then you wait for the benefits to pay off over time. So what is the break-even point for parathyroid surgery? That’s been carefully studied, and the answer is three years. If your life expectancy exceeds three years, then parathyroid surgery is generally considered worthwhile.

You may have read that age is a consideration in determining whether someone is a candidate for surgery—and that's true to some extent. But what really matters is not chronological age, but life expectancy.

Let’s consider a typical patient with primary hyperparathyroidism: a 60-year-old woman with some degree of bone loss, otherwise in good health. Her life expectancy exceeds 20 years. For her, the benefits of surgery are clear.

Now you might be wondering: how do we estimate life expectancy? It’s not a perfect science, but here’s how I do it. I ask patients three main questions:

Physical Activity: Are you independently handling chores, shopping, cleaning, and cooking? Do you exercise regularly? The benchmark I use is this—can you climb two flights of stairs without getting short of breath? If yes, that’s a strong indicator of good life expectancy.
Social Support: Do you have family, friends, and community involvement? A robust social life is strongly correlated with life expectancy.
Future Orientation: I ask patients to tell me something they’re looking forward to doing, whether they are making long-term plans. Future orientation is also linked to longevity.

Honestly, I don’t focus much on chronological age. Two 80-year-olds can be entirely different in terms of overall health. I care more about physiologic age—how your body is functioning—when considering someone for surgery.

So what if you’re 80? Is it still worth it to have parathyroid surgery? For many 80 year-olds, the available time horizon for the investment of parathyroid surgery to pay off may be more limited. However, we still need to take it on a case-by-case basis. Each year, we have many patients in their 80s and even 90s who undergo successful parathyroid surgery.

Now, who isn’t a good candidate for surgery? That’s a relatively small group—people with major health conditions such as significant heart, lung, liver, or neurological disease, where surgery or general anesthesia may pose too high a risk.

But the vast majority of patients we meet—easily more than 90%, maybe 95%—are good candidates for parathyroid surgery. Remember, having parathyroid surgery is almost never an emergency. You have plenty of time to think about it. But if you have high blood calcium levels and good life expectancy, you are probably a good candidate for parathyroid surgery.

I hope this answers your question. Thank you so much for watching.