A Family Doctor's Tale - HYPOPARATHYROIDISM

DOC I HAVE HYPOPARATHYROIDISM

Hypoparathyroid disease is a condition when the parathyroid gland produces too little parathyroid hormones resulting in hypocalcemia.

Hypoparathyroid disease is caused by:
Primary
Primary Hypoparathyroid disease is a rare congenital condition which usually occurs in children below the age of sixteen but can persists throughout adult life

Secondary.
Secondary Hypoparathyroid disease is usually related to surgical resection of the thyroid during which partial to total removal of the parthyroid gland occurs.

As a result of better surgical techniques , less permanent loss of the parathyroid glands occurs during throidectomy.

Instead transient deficiency may occur due to injuries to the parathyroid glands during the surgery, temporary reduction of blood supply to the parathyroid gland and hemorrhage during the surgery.

Neither the administration of radfioactive iodine or radiation to the thyroid gland has been known to cause Secondary Hypoparathyroid disease.

Symptoms:
1.tetany from lowered blood calcium

Tetany which appeared in 70 per cent of cases appears as a carpopedal spasm where the stiff hollowed hand with rigid fingers is flexed at the second metacarpal-phalangeal joint, wrist and elbow joints and the legs and feet are extended.

2.epileptic fits and tonic convulsions occurs in 40 per cent of cases

3.laryngeal spasm of muscles (may be dangerous)

4.spasm of the smooth muscle of blood vessel causing numbness due to poor blood circulation

5.diarrhea due to spasm of the smooth muscles of the gastrintestinal tract

6.mental changes including anxiety, depression, psychoses

Signs:
1.neuromuscular excitabilty may show up as contraction of the facial muscles in response to a light tap on the facial nerve in front of the ear(Chvostek's sign)

2.Dorsal flexion and abduction of the foot may occur by a tapping the lateral surface of the fibula just below its heal(Peroneal sign)

3.Inflation of a blood pressure cuff above the systolic pressure may cause the hand the typical position seen in carpopedal spasm(Trousseau's sign)

4.Skin is dry rough and scaly with patchy or generalised erythema

5.Nails may be brittle with transverse ridges

Diagnosis:

1. blood test is done for presence of low  parathyroid hormone levels.

2. Blood calcium is low in hypoparathyroidism

3. Blood phosphate is high in primary

Treatment:
1.Hypocalcemia is treated with intravenous injections of calcium gluconate under cardiac monitoring as excess calcium may affect the heart

2.oral Calcium supplements(Calcium Chloride is the most effective) is given in most cases as a long term treatment usually with improvement of blood Calcium level

3.Large doses of Vitamin D may be necessary in some cases.

4.Treat underlying cause.

5.Frequent monitoring of progress by blood studies

Prognosis:
is good in most cases depending on rapidity of treatment and cause.

Prevention:
surgery of thyroid gland should be done carefully so as not to remove the parathyroid gland or damage it