A 50 year old male had a total thyroidectomy followed by thyroid hormone-replace

Question

A 50 year old male had a total thyroidectomy followed by thyroid hormone-replacement therapy. 36 hours later he developed muscle cramps in his arms and hands and mild tetany. The following tests were performed

urinary calcium            20 mg/dL (normal: 5 to 15 mg/dl)

urine phosphorous      0.1 g/day (normal: 0.075 to 1.0 mg/day)

plasma calcium            6.0 mg/dL (normal is 8.5 - 10.5 mg/dL)

plasma phosphorous   5.0 mg/dL (2.7 - 4.5 mg/dL)

Calcium gluconate and vitamin D (calcitriol) were given orally each day and the tetany and muscle spasm were alleviated

1) What endocrine disorder is present in this person? Explain your answer using the data provided.

2) What is the purpose of the administration of vitamin D with the calcium?

3) What are some signs and symptoms a patient might experience who is suffering from this disorder?

4) Draw or describe the negative feedback pathway for the main hormone involved.

Explanation / Answer

1.The endocrine disorder is hypoparathyroidism.The reports clearly depicts so.In hypoparathyroidism,the blood calcium levels becomes low while phophorous level increases{plasma calcium- 6.0 mg/dL (normal is 8.5 - 10.5 mg/dL) andplasma phosphorous -5.0 mg/dL (2.7 - 4.5 mg/dL)}.Also, due to hyperparathyroidism, less calcium is reabsorbed from urine.So urine calcium levels increase(urinary calcium- 20 mg/dL (normal: 5 to 15 mg/dl) and less phosphates are excreted into urine.{urine phosphorous- 0.1 g/day (normal: 0.075 to 1.0 mg/day)}

2.The purpose of administration of vitamin D with calcium is that it vitamin D will help in the absorbtion of calcium into the blood from the intestine( from what we eat and from supplements taken.)

3.The signs and symptoms are impaired muscle contraction,cramps in muscles followed by tetany, problems in nerve conduction process,pain in bones, fatigue and headache.

4.The negative feed back mechanism is such that when serum calcium level is low, parathyroid hormone is secreted from parathyroid cells but as the calcium level increases in the serum, the secretion of parathyroid hormone is inhibited so that a balance in calcium level in blood is maintained.

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