RESUMO
The clinical characteristics of patients with postoperative hypoparathyroidism who recover parathyroid function more than 12 months after surgery have not been studied. We aimed to evaluate whether the intensity of replacement therapy with calcium and calcitriol is related to the late recovery of parathyroid function. We compared the demographic, surgical, pathological, and analytical features of two groups of patients: cases, i. e., late recovery patients (those who recover parathyroid function>1 year after thyroidectomy, n=40), and controls, i. e., patients with permanent hypoparathyroidism (n=260). Replacement therapy with calcium and calcitriol was evaluated at discharge of surgery, 3-6 months, 12 months, and last visit. No significant differences were found in clinical, surgical, pathological, or analytical characteristics between cases and controls. The proportion of cases who required treatment with calcium plus calcitriol at 12 months was significantly lower than that found in controls (p<0.001). Furthermore, daily calcium and calcitriol doses in controls were significantly higher than those in cases at 3-6 months (p=0.014 and p=0.004, respectively) and at 12 months (p<0.001 and p=0.043, respectively). In several models of logistic regression analysis therapy with calcium and calcitriol at 12 months was negatively related to late recovery of parathyroid function. Although delayed recuperation of parathyroid function after total thyroidectomy is uncommon (13%), follow-up beyond 12 months is necessary in patients with postoperative hypoparathyroidism, especially in those whose needs of treatment with Ca and calcitriol are reducing over time.
Assuntos
Hipoparatireoidismo/reabilitação , Glândulas Paratireoides/fisiopatologia , Tireoidectomia/efeitos adversos , Adulto , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Hipoparatireoidismo/etiologia , Hipoparatireoidismo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/reabilitação , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Espanha , Tireoidectomia/reabilitação , Fatores de TempoRESUMO
Here we present a case of a coincidence of addiction to "Kratom" (botanically known as Mitragyna speciosa Korth) and developed severe primary hypothyroidism. We are discussing a possibility that high dose of indole alkaloid mitragynine (the major alkaloid identified from "Kratom") might reduce the normal response of the thyroid gland to thyroid-stimulating hormone resulting in primary hypothyroidism. Further experimental investigations of mitragynine as a possible suppressor of thyroid gland function would be a matter of interest.
Assuntos
Hipoparatireoidismo/epidemiologia , Mitragyna/efeitos adversos , Extratos Vegetais/efeitos adversos , Alcaloides de Triptamina e Secologanina/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Buprenorfina/uso terapêutico , Comorbidade , Quimioterapia Combinada , Humanos , Hipoparatireoidismo/reabilitação , Masculino , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Tiroxina/uso terapêuticoRESUMO
We report on a 2-year old boy with the characteristic features of Di George syndrome. The diagnosis was confirmed by history, biochemical, immunologic and radiologic findings. After physical exercise he developed an unilateral epiphysiolysis capitis femoris, rarely seen in this age and not known to be a complication of hypoparathyroidism.