What Is Parathyroiditis?

Parathyroid disease is a type of systemic systemic response caused by increased or decreased parathyroid hormone. There are generally four parathyroid glands in humans, which are located on the two walls of the posterior thyroid gland and mainly secrete parathyroid hormone (PTH). The secretion of PTH is affected by the concentration of serum calcium, calcitonin, blood phosphorus, and magnesium. Clinically common parathyroid diseases include hyperthyroidism and hypothyroidism.

Basic Information

Visiting department: Endocrinology
Common causes: Hypoparathyroidism, pseudohypoparathyroidism, primary hyperparathyroidism, etc.

Common symptoms: Hand and foot convulsions recurrent, frequent active urinary tract stones and so on.
Contagious: no

Causes of parathyroid disease

1. Defects in any link between glands or target cells of hypoparathyroidism, genetic and surgical injuries can cause the disease.
2. Pseudohypoparathyroidism This disease is caused by the surrounding tissues (kidneys and bones) that have no or no physiological effect on PTH or genetic defects.
3. Primary hyperparathyroidism This disease is caused by excessive secretion of PTH caused by parathyroid adenoma, hypertrophy or adenocarcinoma.
4. Secondary hyperparathyroidism vitamin deficiency, gastrointestinal tract and hepatobiliary and pancreatic diseases, chronic phosphate deficiency and hypophosphatemia, excessive calcitonin, pregnancy, breastfeeding, hypercortisolism, etc., all Can cause this disease.

Clinical manifestations of parathyroid disease

1. The most characteristic clinical manifestation of hypoparathyroidism and hypocalcemia is episodic hypocalcemia based on chronic hypocalcemia. Long-term hypocalcemia can have the following clinical manifestations.
(1) Psycho-nervous system: Due to the increased excitability of the neuromuscular system, it can cause epileptic seizures, hysteria-like seizures, neurasthenia symptoms, peripheral neuromuscular symptoms, autonomic symptoms and central nervous symptoms.
(2) Eye: Cataract is more common in patients with chronic hypocalcemia, often bilateral, and its severity is related to the duration of hypocalcemia and blood calcium levels.
(3) Heart: Long-term hypocalcemia can cause stubborn heart failure, hypotension, and resistance to digitalis and booster drugs. (4) Skin: The skin is dry and exfoliated, and the toenails are brittle and fragile. Dermatitis of herpes-like pustular disease or pustular psoriasis is unique to hypocalcemia.
(5) Teeth: Can cause enamel hypoplasia and permanent teeth.
(6) Blood system: Hypocalcemia makes vitamin B12 poorly combined with internal factors, and large cell anemia can occur.
2. Hyperparathyroidism (1) Hypercalcemia: The clinical manifestations involve multiple systems. The appearance and severity of symptoms are related to the rate of increase of blood calcium levels and patient tolerance. Memory loss, emotional instability, apathy, personality changes, burnout, weakness in the limbs, etc. may occur.
(2) The skeletal system: Bone pain may occur in the early stage of the patient, which mainly occurs in the lower back, hips, ribs and limbs, with local tenderness. In the later stage, fibrocystic osteitis is the main manifestation of skeletal deformities and pathological fractures, short stature, difficulty walking, and even bedridden. Some patients may have bone cysts, which are manifested as localized bone bulging.
(3) Urinary system: long-term hypercalcemia can cause symptoms such as polyuria, nocturia, thirst, kidney stones and renal calcification, recurrent renal colic and hematuria, and urinary stones can induce urinary tract infection Or cause urinary tract obstruction, affecting renal function.

Examination of parathyroid disease

1. Hypoparathyroidism Decreased blood calcium, increased blood phosphorus, normal or slightly lower blood ALP; increased or decreased blood magnesium; decreased urine calcium and phosphorus; reduced blood PTH (hormonal deficiencies), normal or elevated (Hormone resistance). Imaging examination can reveal calcification of basal nodules, bone density often increased or normal. Electrocardiogram shows ST segment prolongation, QT interval prolongation, and T-wave abnormalities, and abnormal EEG can occur.
2. Hyperparathyroidism (1) Serum PTH> 100ng / L, blood calcium> 2.7mmol / L, blood phosphorus L, urine calcium> 200mg / 24h.
(2) X-ray showed that the bone was thin, thin and deformed, and there were multiple transparent cysts in the bone.
(3) B-mode ultrasound and CT are the preferred methods of localizing adenomas. A cervical posterior thyroid mass was found to help diagnosis and localization.
(4) Radionuclide scanning imaging of parathyroid glands can clarify the number and location of glands involved in the diseased parathyroid glands, and can understand the existence of ectopic parathyroid glands.

Diagnosis of parathyroid disease

1. Patients with recurrent episodes of hypoparathyroidism, hand-foot convulsions, positive Chvostek sign and Trousseau sign, laboratory tests such as decreased blood calcium, increased blood phosphorus, and can rule out renal insufficiency, the diagnosis can be basically determined.
2. Hyperparathyroidism has one of the following characteristics should be suspected as the disease.
(1) Frequent active urinary tract stones or renal calcium deposits.
(2) Bone resorption, decalcification, and even cyst formation.