Gipoparatireoz – the disease developing owing to a lack of a paratgormon, sekretiruyemy parathyroid glands or violations of receptor fabric sensitivity to it. Decrease in functional activity of parathyroid glands of various genesis is observed at 0,3 — 0,4% of the population and can arise at any age, leading to violation of exchange of calcium and phosphorus. Distinguish congenital, postoperative, post-traumatic, autoimmune and idiopathic . During diagnostics of a gipoparatireoz determination of content of a paratgormon, Sa and P in blood, identification of an osteosclerosis is important at a radiological research and densitometry.
Gipoparatireoz – the disease developing owing to a lack of a paratgormon, sekretiruyemy parathyroid glands or violations of receptor fabric sensitivity to it. Decrease in functional activity of parathyroid glands of various genesis is observed at 0,3 — 0,4% of the population and can arise at any age, leading to violation of exchange of calcium and phosphorus.
Reasons of a gipoparatireoz
Paratgormon together with hormone of a thyroid gland a calcitonin and vitamin D is responsible for regulation in an organism of phosphorus-calcium exchange. Its shortcoming causes decrease in blood of level of calcium and the increased content of phosphates. The mineral balance (balance between ions To, Na, Mg), permeability of cellular membranes is as a result broken that is shown by strengthening of neuromuscular excitability and spasms. Gipokaltsiyemiya and a giperfosfatemiya promote adjournment of salts of calcium in internals and on walls of blood vessels.
Development of a gipoparatireoz quite often happens is connected with diseases of a thyroid gland that is explained by their close anatomic arrangement and close functional interrelation. Gipoparatireoz can develop as a result:
- surgical intervention on a thyroid gland or other bodies of a neck with injury of parathyroid glands. So-called, postoperative usually arises after full removal of a thyroid gland (tireoidektomiya) at the oncological diagnosis;
- hemorrhages in parathyroid glands at neck injuries;
- inflammatory processes in parathyroid glands;
- tumoral metastasises in parathyroid glands and areas of a neck;
- congenital pathology (pre-natal underdevelopment of parathyroid glands) - meets at Di Georgie's syndrome, the characterized violation of development of parathyroid glands, aplaziy a timusa and congenital heart diseases;
- influences of radiation (at treatment of a toxic craw radioactive iodine);
- endocrine violations (primary hypothyroidism, chronic nadpochechnikovy insufficiency);
- autoimmune syndrome, system diseases (hemochromatosis and ).
Classification of a gipoparatireoz
The modern endocrinology allocates the following forms of a gipoparatireoz caused by character of a course of a disease:
- sharp - a state is difficult compensated, often there are heavy attacks of spasms;
- chronic - infrequent attacks are provoked by infections, physical activity, a nerve strain, periods, a psychological trauma). Aggravations of a gipoparatireoz usually arise in the spring and in the fall. Adequate treatment allows to achieve long remission.
- latent (hidden) – external manifestations are absent, it is found only when carrying out special inspection.
Taking into account the reason allocate :
- postoperative (after surgical interventions on thyroid and okoloshchitovidny glands);
- post-traumatic (after beam and infectious influence, hemorrhages etc.);
- idiopathic, autoimmune;
- congenital (as a result of absence or an underdevelopment of parathyroid glands).
Symptoms of a gipoparatireoz
The main clinical manifestation of a gipoparatireoz - a convulsive (titanic) syndrome. Strengthening of neuromuscular excitability at insufficient secretion of a paratgormon leads to spasms - the strong muscular contractions which are followed by pain.
The feeling of a sleep, constraint of muscles, "crawlings of goosebumps" over an upper lip, on fingers of hands and legs, a pricking, a cold snap of extremities can precede an attack of spasms. After harbingers there are spasms of separate groups of the muscles symmetrized on both sides (usually muscles of hands, then - muscles of legs). Face muscles are sometimes affected, muscles of a body and internals are more rare.
Depending on the muscles cramped by a spasm characteristic manifestations from appropriate authorities develop.
The convulsive syndrome at a gipoparatireoza is shown by a spasm of muscles:
- the top and lower extremities (muscles – sgibatel mainly are surprised). At spasms in hands - the top extremity is bent in elbow and carpal joints and pressed to a trunk;
- persons (the compressed jaws, the lowered mouth corners, the shifted eyebrows, the semi-lowered eyelids are characteristic);
- heart vessels (sharp pain is felt);
- trunks (there is an extension of a trunk back);
- necks, intercostal muscles, a diaphragm and muscles of a stomach (leads to breath difficulty, short wind, a spasm of bronchial tubes);
- gullet, stomach, intestines (swallowing violation, locks, intestinal colic are observed);
- bladder with manifestation of an anury (lack of urination).
At a gipoparatireoza of a spasm differ in morbidity, at an easy form of a disease there are 1-2 times a week, minutes can last; at a severe form arise repeatedly per day and several hours proceed. Can spontaneously appear, and can be provoked by any external irritants (mechanical, painful, thermal, electric). The spasm of muscles can be followed by pallor of skin, pressure differences, heartbeat, disorder of digestion (vomiting, a diarrhea). In hard cases of a gipoparatireoz patients can faint.
Vegetative violations at a gipoparatireoza are shown by symptoms of the increased perspiration, dizzinesses, faints; a ring, feeling of "mortgaging" in ears, decrease in hearing; violations of visual concentration and twilight sight; pains and violation of warm reductions; violation of sensitivity of receptors (acoustical - increase in sensitivity to sharp sounds, noise, loud music; flavoring – decrease in a susceptibility to sour and increase to sweet and bitter, violation of adequate perception of surrounding temperature - feeling of cold or heat).
At the long low Ca level in blood at patients with gipoparatireozy changes of mentality are noted: decrease in intelligence, memory, neurosises, emotional lability (depression, melancholy), frustration of a dream.
The chronic current of a gipoparatireoz leads to trophic violations. The peeling, dryness and change of pigmentation of skin, fragility of nails, emergence on skin of vesicles with serous contents, eczema, fungal diseases are characteristic. Violation of growth of hair, partial or full baldness, an early posedeniye is noted. Tissue of teeth is damaged: at children formation of teeth is broken, sites of a hypoplasia of enamel are found; patients of all age groups have a damage of enamel of teeth, development of caries. At children lag in growth is also observed.
At a long gipoparatireoz development of a cataract is possible (a cataract with decrease in visual acuity and development of a blindness). At the latent course of a disease spasms of muscles can arise at sharp infections, intoxication, pregnancy, a vitamin deficiency.
Complications of a gipoparatireoz
At sharp decrease in the Ca level gipokaltsiyemichesky crisis (tetaniye) develops in blood. The convulsive attack arises spontaneously or as a result of external irritation (mechanical, acoustic, hyperventilations). Usually, it begins suddenly, is more rare from symptoms – harbingers (emergence of the general weakness, a paresteziya in a face and in finger-tips), at the same time bystry twitchings of separate muscles are noted, then - tonic or clonic spasms.
At a spasm of muscles of hands the tone of sgibatelny muscles amplifies, (the hand accepts a position of "the obstetrician's hand"). At muscular spasms in legs razgibatelny muscles are stronger strained (bending of a sole – "horse foot"). Morbidity of spasms is noted during tetaniya attacks, but the patient is in consciousness. The spasm of smooth muscles can be shown by hepatic or renal colic.
Development of a bronchospasm and laryngospasm sharply breaks breath and poses hazard to life of patients gipoparatireozy, especially children. At a gipoparatireoza the complications caused by long insufficiency of calcium - a cataract, a kaltsifikation of tissues of brain and other bodies have irreversible character.
Diagnostics of a gipoparatireoz
Diagnostics of obvious clinical forms of a gipoparatireoz is based on results of external survey of the patient, presence of the typical anamnesis (the undergone operations on thyroid or parathyroid glands, radiation therapy by radioactive iodine), symptoms of the increased neuromuscular excitability (convulsive readiness or attacks of tonic spasms).
Laboratory diagnostics of a gipoparatireoz means a research of level of calcium and phosphorus, a paratgormon in blood and urine. At a gipoparatireoza the giperfosfatemiya, a gipokaltsiyemiya, decrease in concentration of a paratgormon in blood serum, a gipokaltsiuriya, a gipofosfaturiya is noted.
On roentgenograms the osteosclerosis, calcification of costal cartilages, by results of densitometry - the increased density of bones is defined. MRT reveals adjournment of Ca in internals, hypodermic cellulose, brain gangliya. For detection of the latent forms of a gipoparatireoz carry out tests on definition of the increased convulsive readiness, test with a hyperventilation.
Treatment of a gipoparatireoz
Therapy of a gipoparatireoz and the prevention of convulsive attacks is carried out under constant control of the endocrinologist. The diet rich with calcium, magnesium and poor in phosphorus (dairy products, vegetables, fruit) is appointed. Sharp restriction or refusal of meat products it is necessary in the period of an aggravation of a gipoparatireoz. Reception with food of D2 vitamin (ergokaltsiferol) which contains in a yolk of eggs, a liver, cod-liver oil is important.
At a gipoparatireoza calcium medicines are appointed (calcium a carbonate, a calcium gluconate). For increase in absorption in intestines of calcium its simultaneous reception with ammonium chloride, gastric juice or the divorced hydrochloric acid is obligatory. Compensation of a state at a gipoparatireoza monotherapy of calcium does not allow to normalize completely its level in blood therefore in addition apply vitamin D medicines (, , ). For activation of production of vitamin D in own organism moderate physiotherapeutic ultra-violet radiation or acceptance of solar bathtubs is recommended to patients with a chronic gipoparatireoz.
For prevention of a convulsive syndrome appoint the anticonvulsive and calming medicines (luminal, bromides); in case of gipokaltsiyemichesky crisis intravenously enter calcium gluconate solution.
The forecast at a gipoparatireoza
Predictive data at a gipoparatireoza – favorable. Treatment of a gipoparatireoz and the prevention of convulsive attacks demand constant control of the doctor-endocrinologist. Control is exercised for the purpose of assessment of compensation of a disease and correction of a course of treatment of 1 times in 3 months, once in half a year is necessary survey of the doctor – the oculist concerning possible development of a cataract.
Prevention of a gipoparatireoz
For the purpose of the prevention of a gipoparatireoz when carrying out surgical intervention on a thyroid gland the sparing quick technicians in relation to parathyroid glands are applied. Patients with a recurrent toxic craw in order to avoid development of a gipoparatireoz are recommended to carry out radiation therapy by radioactive iodine instead of surgery. Prevention of postoperative complications (solderings, infiltrates) which can break blood supply of okoloshchitovidny glands, and also early detection at patients after surgical intervention on a thyroid gland of symptoms of the increased neuromuscular excitability and timely taking measures is important.
The prevention of a convulsive syndrome and development of sharp gipokaltsiyemichesky crisis at a gipoparatireoza requires an exception of provocative factors, prevention of intoxications and infections. Patients with gipoparatireozy need to adhere to a diet: it has to be enriched with calcium and is limited to phosphorus, it is necessary to refuse meat products as they cause development of a tetaniya completely. At a gipoparatireoza dispensary control of the maintenance of Ca and P in blood is exercised.