Hypoparathyroidism - Causes, symptoms and treatment. MF.

Hypoparathyroidism - a disease in which the content of parathyroid hormone decreases or disappears completely, which leads to a violation of calcium absorption in the intestine, a decrease in its excretion from the bones, a decrease in its reverse absorption in the kidneys.

The lack of parathyroid hormone leads to a decrease in the calcium content and increase of phosphates in the blood, which leads to an increase in neuromuscular excitability, which results in convulsions.

Basic information about the function of parathyroid( parathyroid) glands.

Parathyroid glands are the most "young" organ discovery of endocrinologists. For the first time they were described by the Swedish anatomist IK Sundstriem in 1880.A person has four parathyroid glands, which are located two on each side of the posterior surface of the thyroid gland. However, there may be deviations in the number of glands( may be 3.5 or 6), and their position( may be located in the thickness of the thyroid gland).

Parathyroid glands produce parathyroid hormone, which together with vitamin D and calcitonin( thyroid hormone) regulate the exchange of calcium and phosphorus in the body.

The human body contains about 1kg.calcium, 99% of which is found in the bones, and 1% in the soft tissues. Every day a person consumes about 1 gram of food.calcium.

The phosphorus content is about 600 g.(85% in the skeleton, 15% in soft tissues), and 25 g of magnesium. With food daily comes about 2g.phosphates, which are suppliers of phosphorus, which is extremely necessary for our body.

General information on hypoparathyroidism

Hypoparathyroidism is a disease in which the content of parathyroid hormone decreases or disappears completely, which leads to a violation of calcium absorption in the intestine, a decrease in its excretion from the bones, a decrease in its reverse absorption in the kidneys.

The lack of parathyroid hormone causes a decrease in the amount of calcium and an increase in phosphates in the blood, which leads to an increase in neuromuscular excitability, which results in convulsions.

Disturbances in the exchange of calcium, phosphorus, magnesium promote the development of chronic forms of this disease, the disruption of tissue nutrition, which is manifested by a slowing of growth in children, changes in the skin and lens.

There are 3 forms of hypoparathyroidism:

• Acute - occurs with frequent and severe attacks of neuromuscular excitability( convulsions) and is difficult to compensate.
• Chronic - attacks are not frequent, and arise due to physical activity, infection, mental trauma, menstruation, nervous overexertion. Exacerbations occur more often in the spring and autumn. With a properly selected treatment, you can achieve long, unassailable periods.
• Latent - without visible external symptoms, is detected only with a special examination.

Symptoms of hypoparathyroidism

When hypoparathyroidism symptoms are combined into 4 groups of syndromes( symptoms that have the same mechanism of occurrence and characterize a particular state of the body):

1. A tetanic, convulsive syndrome( increased neuromuscular excitability).
2. Syndrome of changes in sensitivity and autonomic functions( functions of internal organs).
3. Syndrome of damage to the central nervous system, brain disorders.
4. Skin changes and trophic disorders( eating disorders of tissues).

A tetanic, convulsive syndrome with hypoparathyroidism

This syndrome is the leading hypoparathyroidism of .It is characterized by an increase in neuromuscular excitability, which manifests itself in the form of convulsions( contraction of the muscle for a certain period of time, accompanied by pain).

Seizures do not appear suddenly, they are preceded by precursors: paresthesia( numbness, crawling crawling on the hands and feet), burning, tingling, tension, stiffness in the muscles of the hands and feet. After harbingers develop seizures of individual muscles. They extend to separate muscle groups, symmetrically on both sides. Most often involved muscles of the upper limbs, then convulsions move to the muscles of the lower extremities. Sometimes the muscles of the face are involved, much less often the muscles of the trunk and internal organs.

With seizures, characteristic changes occur on the part of the organs, depending on which muscles are affected.

The following muscles are cramped:

• of limbs - flexors are most often affected( muscles that provide flexion of limbs).With convulsions of the upper limbs, the arm is brought to the trunk, bent at the elbow and wrist joints.
• , when the muscles of the face are affected, it acquires a characteristic appearance: the corners of the mouth drop, the mouth acquires a "fish" shape, the eyebrows are shifted, the eyelids are half-empty.
• trunk, with the reduction of their extension of the trunk posteriorly;
• esophagus, which leads to swallowing disorders;
• spasm of the musculature of the intestines causes constipation and intestinal colic( stitching in the central abdominal region);
• may cause anuria( no urination) due to spasm of the musculature of the bladder.

Cramps in hypoparathyroidism are very painful and can last from minutes to several hours, can occur spontaneously and be caused by any stimuli( pain, temperature, electrical, mechanical), can occur due to muscle tension with intense physical exertion, nervous shock, when taking a hot bath, with straightening limbs.

Seizures may be accompanied by pallor, increased or decreased pressure, increased or decreased heart rate, vomiting, diarrhea. In very severe attacks, patients may lose consciousness.

Syndrome of changes in autonomic functions and changes in sensitivity

Vegetative disorders in patients manifest themselves in the form:

• sensation of cooling or heat;
• sweating( increased sweating);
• dizziness( sensation of moving surrounding objects or your own body and imbalance).
• fainting( short-term loss of consciousness);
• ringing in the ears;
• impaired concentration of visual attention and visual impairment in the dark( twilight vision);
• sensations of "pawning" the ears;
• sometimes pain and impaired heart contraction( heart failure).

Sensitivity changes are characterized by increased sensitivity to noise, sharp sounds, loud music. There is a change in the perception of the temperature of the environment( when everyone is warm, the patient is cold and vice versa).The sensitivity is also disturbed by taste buds: a decrease in sensitivity to acid and an increase in bitter and sweet.

Syndrome of central nervous system damage, cerebral dysfunction

With prolonged reduced calcium content in the blood, the patient begins to experience changes in the psyche, emotional disorders( depression, melancholy), insomnia.

Skin changes trophic disorders

These changes occur in the chronic course of the disease. It is characterized by dryness, peeling, eczema( skin peeling accompanied by itching), pigmentation or depigmentation is possible, i. E.the skin acquires a heterogeneous color. Perhaps the appearance of the skin on the skin with liquid contents.

Lesions are observed from the appendages of the skin in the form of: growth disturbance, early graying and hair thinning( sometimes falling to full alopecia), fragility, pallor, dullness of the nails, very often the nails are affected by fungal diseases.

Trophic disorders in this case imply a disruption of the nutrition of the tissues of organs, primarily bone, calcium, phosphorus and magnesium. At the same time, changes occur on the part of the dentoalveolar system: in children - dental abnormalities, enamel defects;in patients of all age groups - caries, tooth enamel defects. Children also experience growth retardation.

In the long course of hypoparathyroidism , cataract development is possible - clouding of the lens with a decrease in visual acuity until its complete loss.

Causes of hypoparathyroidism

The causes of hypoparathyroidism are mainly associated with disorders in the thyroid gland, which is explained by the very close interaction between both glands( located in the human body closely adjacent to each other).

To hypoparathyroidism results:

1. Damage to the parathyroid glands or a violation of their blood circulation during thyroid surgery.
2. Removal of glands with their location in the thickness of the thyroid gland.
3. Inflammation of the parathyroid glands with thyroiditis( inflammation of the thyroid gland).
4. The defeat of their radiation in the treatment of thyrotoxicosis with radioactive iodine.
5. Infectious diseases.
6. Incompleteness of development and defeat of the parathyroid gland by the tumor.

Diagnosis of acute and chronic hypoparathyroidism

Acute and chronic forms of hypoparathyroidism are called explicit, since in both cases the symptoms of this disease will be observed in patients, only expressed in varying degrees.

Diagnosis of explicit forms is simple, because it is based on the presence of characteristic symptoms( primarily convulsions).

The diagnosis is made on the basis of the following data:

1. indication in the history( collection of data on the patient's illness according to the patient's words and records in the outpatient card) for surgery on the thyroid gland, parathyroid glands, treatment with radioactive iodine;
2. seizures( according to the patient);
3. decrease in calcium in blood and urine, which is detected in a laboratory study;
4. increase in phosphate levels in the blood and decrease in urine;
5. decreased level of parathyroid hormone in the blood;
6. cardiac electrocardiogram change;
7. cataract( clouding of the lens, leading to poor eyesight).

Diagnosis of the latent form of hypoparathyroidism

Latent form of hypoparathyroidism is extremely difficult to isolate, since there are no characteristic symptoms, therefore for diagnosis use special tests or symptoms.

The symptom of Hvostex is the contraction of the facial muscles when tapping in front of the external auditory meatus( this is the exit point of the facial nerve).

Trusso symptom - convulsions in the hand area 2-3 minutes after pulling the shoulder with a tourniquet or a cuff of the tonometer( apparatus for measuring blood pressure).

Weiss's symptom is a contraction of the eyelid muscle and frontal muscle at the effleurage at the outer edge of the orbit.

The symptom of Hoffmann is the appearance of paresthesias when pressing at the inner edge of the eyebrow( a branch of the branching of the nerves).

Symptom Schlesinger - cramps in the extensor muscles of the thigh and foot with rapid flexion in the hip joint with a straightened knee joint.

Erb Symptom - increased electroexcitability of the nerves of the extremities when stimulated by a weak current, which is expressed in convulsions.

Treatment of hypoparathyroidism

A diet rich in calcium and magnesium salts( milk, dairy products, vegetables, fruits) with phosphorus restriction( meat) is used to treat hypoparathyroidism. Failure of meat products is especially needed during convulsive syndromes. It is advisable to administer ergocalciferol with food, which is contained in fish oil, herring, liver, egg yolk.

For the treatment of the symptoms of the disease, sedative and anticonvulsant drugs( luminal, etc.) are used.