Introduction 1 2 1 3 4 From the clinical standpoint, based on patient self-reporting after surgery, most surgeons have had the impression that parathyroidectomy improves psychological and mental deficits. This prospective study of patients undergoing surgery for incidentally detected, mild, asymptomatic PHPT determined whether subjective neuropsychological symptoms improved postoperatively in patients with asymptomatic PHPT. Patients and methods 1 Fig. 1 pts  Preoperative bone mineral density was measured in the lumbar spine (L2–L4) using a dual-energy X-ray absorptiometer. The serum calcium level was 10.1–12.4 (mean 11.0) mg/dl, the urinary calcium excretion rate was 51–497 (mean 246) mg/24 h, the creatinine clearance rate was 40–183 (mean 90.8) ml/min, and the bone mineral density was 0.2 to −4.8 (mean −2.5) SD. 1 5 Table 1 Questionnaire contents 1. Do you tire easily? 2. Are you forgetful? 3. Do you lack the ability to concentrate? 4. Do you feel depressed? 5. Do you feel irritable? 6. Do you feel uneasiness? 7. Do you experience sleeplessness? a a Statistical analysis P Results General health perceptions 1 year after parathyroidectomy P Comparison of the individual subjective neuropsychological symptoms’ grade  2 Table 2 Comparison of pre- and postoperative scores Neuropsychological symptoms Preoperative 1 year postoperative P No. of patients Score 0 1 2 Easily tired Score 0 8 3 5 0 0.24 1 12 5 7 0 2 5 1 4 0 No. of patients 25 9 16 0 Forgetfulness Score 0 6 1 5 0 0.8 1 15 5 8 2 2 4 0 4 0 No. of patients 25 6 17 2 Decreased concentration Score 0 7 4 3 0 0.3 1 14 6 6 2 2 4 0 4 0 No. of patients 25 10 13 2 Depression Score 0 12 10 1 1 0.17 1 8 4 4 0 2 5 2 2 1 No. of patients 25 16 7 2 Irritability Score 0 13 12 1 0 0.45 1 11 5 5 1 2 1 0 0 1 No. of patients 25 17 6 2 Uneasiness Score 0 10 8 2 0 1 1 13 4 7 2 2 2 0 1 1 No. of patients 25 12 10 3 Sleeplessness Score 0 11 7 3 1 1 1 9 3 6 0 2 5 0 1 4 No. of patients 25 10 10 5 2 Discussion In normal subjects, the serum calcium concentration is always kept within a narrow normal range and plays an important role in the physiological control of neuropsychological functions. In PHPT patients, even in those with the mild form, the abnormally elevated serum calcium concentration returns to the normal level postparathyroidectomy. It has been assumed that some subjective improvement in neuropsychological function must occur following surgery. In the present prospective study of patients with incidentally detected, mild PHPT, 52% of all patients who had successful parathyroidectomy reported improved general health 1 year after surgery. This result was statistically significant. 6 7 8 9 The results of the present study showed that approximately half of the patients reported improvement in general health perceptions, and there was no statistically significant improvement in any of the individual neuropsychological symptoms. The subjective satisfaction with surgery reported by 52% of our patients may also reflect their expectations of treatment. 16 n n n n n n n 11 12 13 6 14 7 15 16 5 6 14 10