Thyroid and parathyroid
Harold Ellis, Sala Abdalla in A History of Surgery, 2018
Radical removal of the thyroid gland may damage the recurrent laryngeal nerve with consequent hoarseness, remove the parathyroid glands with resultant tetany or result in hypothyroidism if insufficient functioning thyroid tissue remains. Operating on the thyroid in a patient with advanced hyperthyroidism in the days before effective drugs were available to control the metabolic complications of the overactive gland was hazardous indeed. The thyroid gland was known to Galen, who thought it produced a fluid to lubricate the larynx. Enlargement of the thyroid gland produced such an obvious physical change in the neck that it has been observed since early times. One common cause of thyroid enlargement is iodine deficiency. In the 19th century, the mortality of thyroid surgery was over 40%, and many leading surgeons advised against the operation. Thyroidectomy was condemned by the French Academy of Medicine in 1850.
Hypocalcaemia
Sherif Gonem, Ian Pavord in Diagnosis in Acute Medicine, 2017
Under normal circumstances, approximately 50% of serum calcium is protein-bound and 50% is in the physiologically active ionised form. Hypocalcaemia may be caused by the following mechanisms: vitamin D deficiency or resistance; parathyroid hormone deficiency or resistance; calcium sequestration; excessive renal calcium excretion; and reduced gastrointestinal calcium absorption. Hypoalbuminaemia increases the proportion of calcium that is ionised, whereas hyperalbuminaemia reduces this proportion. Symptoms of hypocalcaemia include paraesthesiae, muscle cramps or tetany, carpopedal spasm, dysphagia, dysphonia, wheeze and seizures. Mild hypocalcaemia should be treated with oral calcium/vitamin D supplements, whereas severe hypocalcaemia requires intravenous calcium replacement. Involuntary movements due to basal ganglia calcification occur in some cases of chronic hypocalcaemia due to hypoparathyroidism or parathyroid hormone resistance. Acidaemia increases the proportion of calcium that is ionised, whereas alkalaemia has the opposite effect. Thus acute respiratory alkalosis may cause hypocalcaemic tetany as a result of a reduction in ionised calcium levels.
Specific Geomedical Problems in Asia
Jul Låg in Geomedicine, 2017
Iodine deficiency primarily causes goiter, characterized by enlargement of the thyroid gland and cretinism. Endemic goiter has been reported from all over Asia. Symptoms of zinc deficiency in the human population are marked growth retardation, dwarfism, sexual underdevelopment characterized by testicular atrophy with absence of facial, pubic, and body hair, poor appetite, mental lethargy, night blindness, rough, dry skin, and enlargement of the spleen and liver. Geophagia was the characteristic finding in subjects which had a markedly low zinc concentration in their plasma, red blood cells, and hair. Nutritional hemoglobinuria associated with phosphorus deficiency has been found to occur in buffaloes in many parts of India, Pakistan, and Egypt. Magnesium deficiency in animals, that is, lactation tetany in cattle and buffaloes characterized by clonic and tonic muscular spasms, convulsions, and death due to respiratory failure, has been recognized in India and Japan.
Gitelman’s syndrome associated with chondrocalcinosis: a case report
Published in Renal Failure, 2013
Ayşe Şeker Koçkara, Ferhan Candan, Can Hüzmeli, Mansur Kayataş, Demet Alaygut
Gitelman’s syndrome (GS) is a rare disease with autosomal recessive trait, characterized by hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalciuria and hyperkinemic hyperaldosteronism. While muscle weakness, tetany, stomachache, nausea and fever are very common, it could sometimes be completely asymptomatic as is the case in our patient. It is generally benign, but some severe complications like growth retardation and, though rare, paralysis and cardiac arrest could also be seen. A 57-year-old male patient sent to our hospital for further examination because of hypokalemia was diagnosed with GS as a result of clinical and laboratory assessments. Potassium and magnesium replacement was started. We are presenting our case seeing that GS is not a syndrome to be overlooked as it bears a risk of severe complications, although it might be asymptomatic until advanced ages.
Pediatric fatality secondary to EDTA chelation
Published in Clinical Toxicology, 2008
Arla J. Baxter, Edward P. Krenzelok
Background. Chelation therapy has emerged as a popular treatment modality to remove heavy metals that are thought to cause autism. We report a fatality that occurred as a consequence of chelation therapy for autism when the incorrect form of EDTA was administered. Case Report. A five-year-old autistic male was being chelated in a physician's office. While receiving his third treatment he went into cardiac arrest. It was not determined until after the child's death that he had been given edetate disodium rather than edetate calcium disodium, causing profound hypocalcemia and triggering the cardiac events that led to his death. Discussion. In 1991, the CDC recommended using only edetate calcium disodium, not edetate disodium, to children because edetate disodium may induce tetany and possible hypocalcemia as illustrated in this case. Conclusion. The use of chelation therapy in autistic children has not been validated and can have tragic consequences.
Rickets associated with ichthyosis
Published in Paediatrics and International Child Health, 2012
V Kumar, S Kalra, D Mutreja, A Arya
Nutritional rickets in disorders of keratinisation is very rare. A 12-year-old girl with autosomal dominant ichthyosis vulgaris is reported who presented with tetany and a waddling gait. She had the classic clinical, biochemical and radiological features of rickets. She was treated with vitamin D and calcium supplements together with keratolytic and emollient agents, which was followed by biochemical and clinical remission. This appears to be the first report of rickets associated with autosomal dominant ichthyosis vulgaris.
Related Knowledge Centers
- Hypocalcemia
- Magnesium
- Uremia
- Hyperventilation
- Rickets
- Neuromuscular Manifestations
- Hypoparathyroidism