Question

Endocrine Case Histories - Case 29
A 50-year-old male had a total thyroidectomy followed by thyroid hormone-replacement therapy.
Thirty-six hours later he developed laryngeal spasms, a mild tetany, and cramps in the muscles of the
hands and arms. The following tests were performed:
Urine calcium 20 mg/dL
Urine phosphorus 0.1 g/day
Plasma calcium 7.0 mg/dL
Plasma phosphorus 5.0 mg/dL
Calcium gluconate and vitamin D (calcitriol) were given orally each day and the tetany and laryngeal
spasms were alleviated.
1. Discuss this patient’ blood values.

Answer 1

Answer 50 )

As a pateint has undergone thyroidectomy ,and 36 hours later pateint developed laryngeal spasms,Tetany and cramps in muscles of hands and arms ---> It suggest even the Parathyroid glands is also removed .

So the pateint is suffering from Hypoparathyroidism ,As Parathyroid hormones is secreted from Parathyroid glands .

).PTH( Parathyroid hormone )along with Vit D act on osteoclast and leads to resorbtion of Bone releasing Calcium from bone into blood .

2) Intestine : PTH incraeses calcium and phsophate absorption by increasing active form of Vit D.

3.)Kidney : Decrease calcium excretion and increase phosphate excretion.

*So main function of PARATHYROID hormone is to increase Calcium levels in Blood and Decrease phosphate levels.

*When there is deficiency of PARATHYROID hormone it is known as Hypoparathyroidism .

*So PTH action is not there so blood Calcium levels will decrease and Increase phosphate levels in Blood

Decreased PTH ----->Decreased Calcium + Increased Phosphate in blood.

From the blood picture

Plasma Calcium levels is 7 mg/dl ( Normal range is 9-11 mg/dl) .Low Calcium levels in blood

Also Plasma Phosphorus is 5 mg/dl ( Normal range is 2.5-4.5 mg/dl) Blood Plasma levels of Phosphorus is High .

So Low Calcium levels in Plasma and High Phosphorus levels in Plasma ----> Suggetsive of Hypoparathyroidism because of removal of Parathyroid glands during Thyroidectomy .