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.

2. What endocrine gland’s functions are impaired in this case?

3. What endocrine disorder is present in this person?

4. What is the purpose of vitamin D administration with the calcium?

5. What caused the tetany and laryngeal spasms?

6. Describe how blood calcium is normally maintained at its physiological level.

7. Does this patient require hormone replacement for this new condition?
Discuss what could possibly happen if he were not treated with this hormone.

8. List all essential hormones.

Answer 1

1.patient blood values

Plasma calcium - 7mg/dl

Plasma phosphorus - 5.0 mg/dL

In blood value the patients plasma calcium level is decreased it should be maintained within a range from 9 to 10.5 mg/dl

The low calcium levels due to decreased secretion of parathyroid hormone from the parathyroid glands next to the thyroid. This may be occur as a result of damage to parathyroid when performing total thyroidectomy

Serum phosphorus is very slightly elevated because the normal serum phosphorus concentration is about 3.4 to 4.5 mg/dl

2.Both the functions of thyroid and parathyroid endocrine glands are impaired here because hypocalcemia implies damage of parathyroid gland due to decreased secretion of parathyroid hormone

3.Hyperthyrodism due to total thyroidectomy

hypoparathyroidism due to damage to the parathyroid gland

These two endocrine diseases which this patients have

4. Because Vitamin D is essential for intestinal calcium absorption so in the absence of adequate vitamin d in the body the proper absorption of calcium does not take place so we have to administer vitamin D along with the calcium for proper absorption of calcium in intestine.

5.due to total removal of thyroid gland may cause injury to parathyroid gland or decreased blood supply towords parathyroid leads to hypocalcaemic that leads to tetany due to hypoparathyroidism. It is the most common consequence of decreased calcium in blood

6.The parathyroid hormone is responsible for regulating blood calcium levels which is produced by parathyroid galnd which release parathyroid hormone whenever blood calcium levels are low. PTH increases blood calcium levels by stimulating osteoclasts, which break down bone to release calcium into the blood stream and also which help to store calcium in bones and different resorvoirs. In this way the normal calcium is maintained in the body