Hypofunction of the parathyroid glands – a rare, but rather dangerous disease of the parathyroid glands, especially with insufficient correction of the level of parathyroid hormone.
Hypofunction of the parathyroid glands is very often a manifestation of autoimmune polyglandular endocrinopathies. Most often, hypoparathyroidism occurs in the clinic in patients who have been operated on for oncological diseases, goiter and thyroiditis of the thyroid gland.
Find out in our article on estet-portal.com about the symptoms of this disease, as well as the "gold" diagnostic standards based on the principles of evidence-based medicine.
Symptoms of parathyroid hypofunction
One of the main clinical manifestations of parathyroid hypofunction is convulsions. This is due to a decrease in the level of calcium in the blood serum, as a result of its insufficient release from the bones, since there is an imbalance between parathyroid hormone and thyrocalcitonin, which is produced by the thyroid gland.
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It is also very important to know that with spasms of the facial muscles, the reduction of the upper and lower jaws occurs – trismus, lips become elongated – "fish mouth" syndrome, which significantly affects the patient's appearance.
At the same time, these external changes are due to low calcium levels in the blood, and there is also an increased excitability of muscle structures.
Only restoration of hormonal balance, as well as parathyroid function or replacement therapy, can significantly improve the condition of the facial muscles or completely cure the disease.
Diagnosis of parathyroid dysfunction
National Institute for Health and Care Excellence (NICE) have revised their guidelines for the diagnosis and management of patients with primary hypothyroidism to improve clinical screening and management, reduce long-term complications, and improve quality of life for individuals with the condition.
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Diagnosis of parathyroid disorders at the primary level includes: determination of the level of calcium in the blood serum, taking into account serum albumin, determination of the level of calcium in the blood for individuals with symptoms that may indicate hypofunction of the parathyroid glands (convulsions, contraction of facial muscles, seizures tetany, disruption of the muscles of the upper limb, spasmodic manifestations in the organs of the gastrointestinal tract, bronchi and trachea), determination of the level of phosphorus in the blood.
Calcium and parathyroid hormone levels in the blood
When conducting a diagnosis, given the possibility of primary hypoparathyroidism, determining the level of ionized calcium is not an informative parameter. It is necessary to re-determine the level of calcium in the blood serum, taking into account the level of serum albumin, at least once, if at the initial measurement: ≤ 2.1 mmol / l or 2.1-2.15 mmol / l and there are signs of primary hypoparathyroidism.
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Determination of the level of parathyroid hormone
Determination of the level of parathyroid hormone for individuals whose serum calcium level, taking into account serum albumin, is: ≤2.1 mmol/l in at least two separate tests or ≤2.1 mmol/l in at least two separate tests and presupposition of primary hypoparathyroidism.
When determining the level of parathyroid hormone, it is necessary to focus on a random indicator and at the same time determine the content of calcium and phosphorus (the norm is 0.65-1.6 mmol / l) in the blood serum, taking into account serum albumin. Parathyroid hormone levels should not be routinely measured when providing medical support at the primary care level.
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It is necessary to refer the patient to narrow-profile specialists – endocrinologist (secondary diagnostics), if parathyroid hormone values are: below the mean values of the control range and if primary hypoparathyroidism is suspected, or above the mean of the reference range with a serum calcium level taking into account serum albumin ≤ 2.1 mmol / l. Secondary diagnostics includes determining the level of calcium, phosphorus, parathyroid hormone, ultrasound of the thyroid gland, if necessary − biopsy of the parathyroid glands.
Alternative causes must be ruled out, including malignancy, if parathyroid hormone levels are below the lower control range.
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Treatment of parathyroid hypofunction
It is important to remember that with a long course of hypoparathyroidism, changes appear on the part of the skin, since spasm attacks of the facial muscles affect the tone and cause the formation of wrinkles faster. Also, there is fragility of hair and nails, delamination of the nail plate, due to a lack of calcium, earlier baldness, gray hair is possible.
For individuals with a likely diagnosis of primary hypoparathyroidism, vitamin D levels should also be assessed and vitamin D supplementation given as needed.
Treatment of parathyroid hypofunction is most often carried out in two stages: relief of an attack of seizures and subsequent replacement therapy with calcium preparations in combination with vitamin D, as well as taking the hormone parathyroidin at a dose of 1-2 ml / m 2 times a day.
Patients with hypofunction of the parathyroid glands must strictly observe the daily regimen: work at night is excluded, in rooms with high temperature, and also regularly undergo examination by an endocrinologist.
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