scholarly journals Bilateral hypocalcemic cataract after total thyroidectomy in a young woman: Case report

2019 ◽  
Author(s):  
kumale tolesa daba ◽  
Dagmawit Kifle W/ Michael ◽  
Gersam Abera Mulugeta
Keyword(s):  
Case Report ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Soft Tissues ◽  
Posterior Cortex ◽  
Thyroid Gland Surgery ◽  
Systemic Examination ◽  
Toxic Goiter

Abstract Background: Hypocalcemia is a derangement in serum calcium level due to a vast spectrum of disorders, but the most common cause is surgery, usually thyroid gland surgery. Symptoms of hypocalcemia can be due to increased neuromuscular excitation resulting in tetany, paresthesia or seizure. It can also be because of deposition of calcium in soft tissues producing reduced vision /cataract or calcification of basal ganglia. Cataract is the most common ocular symptom of hypocalcemia. Case report: A twenty-six years old Ethiopian female patient presented with painless reduction of vision of both eyes. Five years prior to the reduction of vision she was diagnosed to have hypocalcemia. The serum calcium level was very low (3mg/dl) due to damage to the parathyroid gland during total thyroidectomy for toxic goiter. She has been on supplemental calcium gluconate twice daily. She had typical bilateral symmetrical posterior sub capsular cataract with punctate iridescent opacities in the anterior and posterior cortex of the lens. Systemic examination revealed horizontal surgical scar on the anterior neck and positive Chvostek sign.

scholarly journals Bilateral hypocalcemic cataract after total thyroidectomy in a young woman: Case report

2019 ◽  
Author(s):  
kumale tolesa daba ◽  
Dagmawit Kifle W/ Michael ◽  
Gersam Abera Mulugeta
Keyword(s):  
Case Report ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Soft Tissues ◽  
Posterior Cortex ◽  
Thyroid Gland Surgery ◽  
Systemic Examination ◽  
Toxic Goiter

Abstract Background: Hypocalcemia is a derangement in serum calcium level due to a vast spectrum of disorders, but the most common cause is surgery, usually thyroid gland surgery. Symptoms of hypocalcemia can be due to increased neuromuscular excitation resulting in tetany, paresthesia or seizure. It can also be because of deposition of calcium in soft tissues producing reduced vision /cataract or calcification of basal ganglia. Cataract is the most common ocular symptom of hypocalcemia. Case report: A twenty-six years old Ethiopian female patient presented with painless reduction of vision of both eyes. Five years prior to the reduction of vision she was diagnosed to have hypocalcemia. The serum calcium level was very low (3mg/dl) due to damage to the parathyroid gland during total thyroidectomy for toxic goiter. She has been on supplemental calcium gluconate twice daily. She had typical bilateral symmetrical posterior sub capsular cataract with punctate iridescent opacities in the anterior and posterior cortex of the lens. Systemic examination revealed horizontal surgical scar on the anterior neck and positive Chvostek sign. Key words: Hypocalcemia, bilateral cataract, total thyroidectomy, hypoparathyroidism, tetany, serum calcium and Ethiopia.

scholarly journals Bilateral hypocalcemic cataract after total thyroidectomy in a young woman: case report

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kumale Tolesa Daba ◽  
Dagmawit Kifle Weldemichael ◽  
Gersam Abera Mulugeta
Keyword(s):  
Case Report ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Soft Tissues ◽  
Posterior Cortex ◽  
Thyroid Gland Surgery ◽  
Systemic Examination ◽  
Toxic Goiter

Abstract Background Hypocalcemia is a derangement in serum calcium level due to a vast spectrum of disorders, but the most common cause is surgery, usually thyroid gland surgery. Symptoms of hypocalcemia can be due to increased neuromuscular excitation resulting in tetany, paresthesia or seizure. It can also be because of deposition of calcium in soft tissues producing reduced vision /cataract or calcification of basal ganglia. Cataract is the most common ocular symptom of hypocalcemia. Case report A twenty-six years old Ethiopian female patient presented with painless reduction of vision of both eyes. Five years prior to the reduction of vision she was diagnosed to have hypocalcemia. The serum calcium level was very low (3 mg/dl) due to damage to the parathyroid gland during total thyroidectomy for toxic goiter. She has been on supplemental calcium gluconate twice daily. She had typical bilateral symmetrical posterior sub capsular cataract with punctate iridescent opacities in the anterior and posterior cortex of the lens. Systemic examination revealed horizontal surgical scar on the anterior neck and positive Chvostek sign.

scholarly journals Bilateral hypocalcemic cataract after total thyroidectomy in an Ethiopian young woman: Case report

2019 ◽  
Author(s):  
kumale tolesa daba ◽  
Dagmawit Kifle W/ Michael ◽  
Gersam Abera Mulugeta
Keyword(s):  
Case Report ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Soft Tissues ◽  
Young Patients ◽  
Posterior Cortex ◽  
Systemic Examination ◽  
Toxic Goiter

Abstract Introduction: Hypocalcemia is a derangement in serum calcium level due to a vast spectrum of disorders, but the most common cause is surgery, usually thyroid gland surgery. Symptoms of Hypocalcemia can be due to increased neuromuscular excitation resulting in tetany, paresthesia or seizure. It can also be because of deposition of calcium in soft tissues producing reduced vision /cataract or calcification of basal ganglia. Cataract is the most common ocular symptom of hypocalcemia. Case report: A twenty six years old Ethiopian female patient presented with painless reduction of vision of both eyes 5 years after she was diagnosed to have hypocalcemia with very low serum calcium level (3mg/dl) due to damage to the parathyroid gland during total thyroidectomy for toxic goiter and has been on supplemental calcium gluconate twice daily. She had typical bilateral symmetrical posterior sub capsular cataract with punctate iridescent opacities in the anterior and posterior cortex of the lens. Systemic examination revealed horizontal surgical scar on the anterior neck and Positive Chvostek sign. Conclusion:The work up of bilateral symmetrical cataract in young patients should include serum electrolyte levels, particularly calcium, in those who had history of thyroid surgery. Key words: Hypocalcemia, bilateral cataract, total thyroidectomy, hypoparathyroidism, tetany, serum calcium and Ethiopia.

Calcium-Alkali Syndrome Associated with Hypoparathyroidism Following Total Thyroidectomy

2020 ◽  
Vol 51 (2) ◽  
pp. 160-167
Author(s):  
Sayaka Kuroya ◽  
Masahiko Yazawa ◽  
Yugo Shibagaki ◽  
Naoto Tominaga
Keyword(s):  
Vitamin D ◽  
Renal Impairment ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Metabolic Alkalosis ◽  
Calcium Supplementation ◽  
Parathyroid Autotransplantation ◽  
High Calcium

Background: Patients with permanent postsurgical hypoparathyroidism, a complication of total thyroidectomy, often require high calcium supplementation with vitamin D to maintain serum calcium levels. The epidemiology of calcium-alkali syndrome (CAS) in patients with hypoparathyroidism after total thyroidectomy remains unclear. This study aimed to investigate the incidence of hypercalcemia, renal impairment, metabolic alkalosis, and CAS in patients treated for presumed hypoparathyroidism after total thyroidectomy. Methods: Twenty-seven patients with neck cancers who underwent total thyroidectomy without parathyroid autotransplantation between January 2010 and October 2013 at our hospital were consecutively included. All patients received calcium lactate and alfacalcidol for postsurgical hypocalcemia. We defined hypercalcemia as a corrected serum calcium level (cCa) ≥10.5 mg/dL, metabolic alkalosis as a difference in serum sodium and serum chloride ([sNa-sCl]) ≥39 mEq/L, and renal impairment as a ≥50% increase in serum creatine and/or ≥35% decrease in estimated glomerular filtration rate (eGFR) compared to baseline. Results: cCa peaked (11.1 ± 1.5 mg/dL) at a median of 326 days (interquartile range 78–869) after surgery. At peak cCa, [sNa-sCl] was significantly higher (p < 0.01), and eGFR was significantly lower (p < 0.01) than that at baseline. Fifteen patients (55.6%) had hypercalcemia, 19 (70.3%) had alkalosis, 12 (44.4%) had renal impairment, and 9 (33.3%) had CAS. Patients with CAS (mean age 67.1 ± 10.8 years) were older than those without CAS (56.7 ± 13.6 years, p = 0.06). The mean dose of alfacalcidol in the CAS group (3.1 ± 1.2 μg/day) was significantly larger than that in the non-CAS group (2.1 ± 1.0 μg/day, p = 0.03). Conclusions: This retrospective study reveals the high incidence of CAS in patients with hypoparathyroidism after total thyroidectomy. Furthermore, these findings suggest that the serum calcium level, acid-base balance, and renal function should be closely monitored in patients with postsurgical hypoparathyroidism who receive large doses of active vitamin D.

scholarly journals Evaluation of Serum Calcium Level Measurement in Total Thyroidectomy Patients - A Prospective Study in Tertiary Hospitals

2013 ◽  
Vol 4 (1) ◽  
pp. 4-9 ◽  
Author(s):  
MS Islam ◽  
D Paul ◽  
T Sultana ◽  
MQ Rahman ◽  
Z Rehena ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Critical Time ◽  
Clinical Pathology ◽  
Level Measurement ◽  
Tertiary Hospitals ◽  
Symptomatic Hypocalcemia ◽  
A Prospective Study

Postoperative hypocalcemia is the most frequent and common complication after total thyroidectomy. It is necessary to diagnose hypocalcemia immediately after total thyroidectomy for minimizing complications. The objective of this study was to measure and to evaluate the serum calcium level in total thyroidectomy patients. This prospective observational study was carried out in the Department of Clinical Pathology in collaboration with Department of Surgery & Department of Otolaryngology of BSMMU and Department of Otolaryngology of DMCH, Dhaka, during the period of September 2010 to August 2011. Total 65 patients were enrolled those came for total thyroidectomy irrespective of age and sex. Hypocalcemia was found in 25 cases and normocalcemia was found in 40 cases. Male were 16.0% and female were 84.0%. Females were predominant. The incidence of hypocalcemia was 38.5%. Asymptomatic hypocalcemia was found in 22 and symptomatic hypocalcemia was found in 3 cases. Hypocalcemia was developed mostly in malignant thyroid diseases. The mean difference of intraoperative (20 minutes after total thyroidectomy), after 24 hours and after 48 hours calcium levels were statistically significant (p<0.05) between patient with hypocalcemia and patient with normocalcemia in unpaired t-test. Serum calcium level significantly decreased after total thyroidectomy and most critical time is first 24 hours of post-thyroidectomy period. If clinical sign symptoms of hypocalcemia are not developed in this period, patient is safe and can be discharged from hospital.DOI: http://dx.doi.org/10.3329/bjmb.v4i1.13775 Bangladesh J Med Biochem 2011; 4(1): 4-9

A case of severe, irreversible hypocalcemia after one dose of pamidronate administered for hypercalcemia of malignancy

2018 ◽  
Vol 25 (7) ◽  
pp. 1787-1793 ◽  
Author(s):  
Sophie Kim
Keyword(s):  
Vitamin D ◽  
Case Report ◽  
Vitamin D Deficiency ◽  
Cancer Patients ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Elevated Serum ◽  
Baseline Serum ◽  
Hypercalcemia Of Malignancy

This is a case report of a patient who developed severe, irreversible hypocalcemia after receiving one dose of pamidronate 90 mg for hypercalcemia of malignancy. Hypocalcemia is a known risk of bisphosphonate treatments, but the incidence of severe hypocalcemia is rare, and the risk factors are well established. However, in the treatment of hypercalcemia of malignancy, the treatment objective is to reduce the elevated serum calcium level, and the bisphosphonate is usually given as one time dose only. The potential for developing severe hypocalcemia may not be considered a significant concern in this setting compared to the setting of the treatment of bone metastasis, where the baseline serum calcium level is not elevated and the bisphosphonate is administered at a regular interval of every three to four weeks. Furthermore, there is unawareness of prevalence of vitamin D deficiency in cancer patients, especially in those with advanced cancer, which may lead to inadvertent, severe hypocalcemia from bisphosphonate treatment. The objective of this case report is to bring awareness to the risk of severe hypocalcemia in patients with hypercalcemia of malignancy and the high prevalence of unrecognized vitamin D deficiency in cancer patients.

scholarly journals Correlation of pre-operative vitamin D3 levels with post-operative hypocalcemia in patients undergoing total thyroidectomy

2019 ◽  
Vol 7 (1) ◽  
pp. 128
Author(s):  
Mallikarjuna M. N. ◽  
Arun Kumar ◽  
Ramya M. V. ◽  
Santhosh C. S.
Keyword(s):  
Vitamin D ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Vitamin D3 ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Serum Vitamin ◽  
Hypovitaminosis D ◽  
Preoperative Serum ◽  
Vitamin D Levels

Background: Total thyroidectomy (TT) is a commonly performed procedure for various  thyroid disorders, with parathyroid insufficiency manifesting as hypocalcaemia being a well-known complication. Albeit, vitamin D is well implicated in calcium homeostasis, the association between hypovitaminosis D and postoperative hypocalcaemia is yet to be concluded. The aim of our study is to evaluate the correlation of preoperative serum vitamin D3 levels  with occurrence of post-operative hypocalcemia in patients undergoing TT.Methods: A prospective  study  was conducted on 50 patients  undergoing TT for benign thyroid diseases from November 2016 to May 2018. Pre-operative vitamin D3 levels were estimated. Serum calcium levels was measured pre‑ and post‑operatively at 24hours, 1st week and 4th week. Serum calcium level ≤8.5 mg/dl was considered as biochemical hypocalcemia. A data of demographic, clinical, biochemical and intraoperative findings were documented and analysed.Results: Statically 14 (28%) patients developed symptomatic hypocalcemia. Out of these, 11 (78.5%) patients had preoperative vitamin D levels of <30 ng/dl (p=0.034). 24 hours postoperative serum calcium level was significantly  lesser in patients with  lower preoperative vitamin D levels (p=0.015), suggesting that postoperative  hypocalcemia (24 hr) is statistically related to pre-operative vitamin D3 levels.Conclusions: It could be concluded from our study that preoperative serum vitamin D3 levels can predict post-operative occurrence of symptomatic and/or biochemical hypocalcemia. Thus, it could be hypothesized that supplementing vitamin D preoperatively could curb the incidence of hypocalcaemia following TT. However, further relevant trials are needed to attest to this. 

GENERAL EFFECTS OF α-MELANOCYTE STIMULATING HORMONE IN THE RABBIT

1965 ◽  
Vol 48 (4) ◽  
pp. 609-618 ◽  
Author(s):  
H. K. Dyster-Aas ◽  
C. E. T. Krakau
Keyword(s):  
Fatty Acids ◽  
Free Fatty Acids ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Systemic Effects ◽  
List Type ◽  
Aqueous Flare ◽  
Melanocyte Stimulating Hormone ◽  
Blood Aqueous Barrier

ABSTRACT In addition to the previously described permeability disturbance in the blood aqueous barrier of the eye, measured as an increase of the aqueous flare, a series of transitory systemic effects have been recorded following the subcutaneous injection of synthetic α-MSH: marked increase of the free fatty acids in plasma, decrease in the serum calcium level, decrease in the blood pressure, increase in the skin temperature, increased frequency and diminished amplitude of respiration, presence of slow waves in the EEG. There is a correlation between the magnitude of the aqueous flare increase and the increase of free fatty acids in plasma and also between the aqueous flare and the minimum serum calcium level.

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