Hypoparathyroidism (HypoPT) is an endocrine disease with low calcium and inappropriately low (insufficient) circulating PTH levels. HypoPT may have an autoimmune pathogenesis, however, the most common causes of chronic HypoPT are iatrogenic: mostly thyroid or parathyroid surgery. Much less frequently HypoPT...
Case report: A 49-year-old previously healthy man was admitted to the ICU after cardiac arrest following a short history with headache, blurred speech and reduced consciousness. After cardiopulmonary resuscitation perfusion rhythm was regained, but the patient didn`t regain consciousness. The arterial blood gas analysis at the ICU revealed a severe metabolic acidosis with pH at 6.86 and lactate levels of 16 mmol/L. The white blood cells count was also markedly increased (312 * 109/L), and blood smear showed immature cells indicating acute leukemia. The severe metabolic acidosis, at first thought to be due to systemic hypoperfusion, did not improve in spite of fluid and vasopressor resuscitation. A CT scan of the head performed the next day, revealed massive cerebellar haemorrhage, edema in both hemispheres and signs of anoxic brain damage. Immunophenotyping of peripheral blood was consistent with Acute Myeloid Leukemia (AML).
Critical Illness Polyneuromyopathy (CIPNM) is frequently present in critically ill as a certain degree of symmetric extremity paresis and respiratory muscle weakness. The consequences of this complication may last for months or years after severe illness. It prolongs the stay in ICU and dependence onmechanical ventilation, increases long-term disability and care costs. We report a 58-year old female patient admitted to our Intensive Care Unit for acute respiratory insuffi ciency due to infl uenza pneumonia and acute respiratory distress syndrome. Thirty-three days of mechanical ventilation and 11 days of extracorporal membrane oxygenation were complicated by severe CIPNM, tetraparesis, mental disorders, and diffi culties in weaning off mechanical ventilation. No specifi c therapy is available for treatment of CIPNM. Preventive, supportive and rehabilitation measures are discussed in the article.
Hypokalemic Periodic Paralysis A Case Reportijtsrd
"Hypokalemic periodic paralysis HPP is a medical emergency with prevalence of 1 in 100,000 . Rapid management is very important since, very low potassium levels can lead to cardiac complications . In this case, a twenty four year old female without a similar history in the family, having hypokalemia periodic paralysis attack is presented. This case report study has been presented for the consideration of the rare HPP in patients presenting with sudden muscle weakness. Blessy Rachal Boban | Cillamol K. J | Elena Cheruvil | Sheffin Thomas | Tony Abraham ""Hypokalemic Periodic Paralysis: A Case Report"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21658.pdf
Paper URL: https://www.ijtsrd.com/pharmacy/pharmacy-practice/21658/hypokalemic-periodic-paralysis-a-case-report/blessy-rachal-boban"
the scenario given at the start of ppt z nt interstitial lung diseases... its a similar diseases to it.... diagnose it urself to differniate it and hv better command over diffferntial diagnosis.
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...clinicsoncology
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy....
Case report: A 49-year-old previously healthy man was admitted to the ICU after cardiac arrest following a short history with headache, blurred speech and reduced consciousness. After cardiopulmonary resuscitation perfusion rhythm was regained, but the patient didn`t regain consciousness. The arterial blood gas analysis at the ICU revealed a severe metabolic acidosis with pH at 6.86 and lactate levels of 16 mmol/L. The white blood cells count was also markedly increased (312 * 109/L), and blood smear showed immature cells indicating acute leukemia. The severe metabolic acidosis, at first thought to be due to systemic hypoperfusion, did not improve in spite of fluid and vasopressor resuscitation. A CT scan of the head performed the next day, revealed massive cerebellar haemorrhage, edema in both hemispheres and signs of anoxic brain damage. Immunophenotyping of peripheral blood was consistent with Acute Myeloid Leukemia (AML).
Critical Illness Polyneuromyopathy (CIPNM) is frequently present in critically ill as a certain degree of symmetric extremity paresis and respiratory muscle weakness. The consequences of this complication may last for months or years after severe illness. It prolongs the stay in ICU and dependence onmechanical ventilation, increases long-term disability and care costs. We report a 58-year old female patient admitted to our Intensive Care Unit for acute respiratory insuffi ciency due to infl uenza pneumonia and acute respiratory distress syndrome. Thirty-three days of mechanical ventilation and 11 days of extracorporal membrane oxygenation were complicated by severe CIPNM, tetraparesis, mental disorders, and diffi culties in weaning off mechanical ventilation. No specifi c therapy is available for treatment of CIPNM. Preventive, supportive and rehabilitation measures are discussed in the article.
Hypokalemic Periodic Paralysis A Case Reportijtsrd
"Hypokalemic periodic paralysis HPP is a medical emergency with prevalence of 1 in 100,000 . Rapid management is very important since, very low potassium levels can lead to cardiac complications . In this case, a twenty four year old female without a similar history in the family, having hypokalemia periodic paralysis attack is presented. This case report study has been presented for the consideration of the rare HPP in patients presenting with sudden muscle weakness. Blessy Rachal Boban | Cillamol K. J | Elena Cheruvil | Sheffin Thomas | Tony Abraham ""Hypokalemic Periodic Paralysis: A Case Report"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21658.pdf
Paper URL: https://www.ijtsrd.com/pharmacy/pharmacy-practice/21658/hypokalemic-periodic-paralysis-a-case-report/blessy-rachal-boban"
the scenario given at the start of ppt z nt interstitial lung diseases... its a similar diseases to it.... diagnose it urself to differniate it and hv better command over diffferntial diagnosis.
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...clinicsoncology
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy....
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...SarkarRenon
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy....
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...georgemarini
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy....
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...AnonIshanvi
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy....
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...pateldrona
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy..
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...komalicarol
Medulloblastoma is the most common malignant solid tumor
in childhood, with the highest frequency among other brain tumors accounting for 30% of pediatric brain tumors and 7% to 8%
of all brain tumors. According to the World Health Organization
(WHO), medulloblastoma is classified as a grade IV tumor and
defined as “a malignant, invasive embryonal tumor of the cerebellum with preferential manifestation in children, predominantly
neuronal differentiation and an inherent tendency to metastasize
via cerebrospinal (CSF) pathways
Thrombophylia and COVID-19. A case report of young man 53 years old whith acu...komalicarol
A 57-year-old male was admitted to our Hospital on March 2020
for SARS-Cov2 related interstitial pneumonia. Chest x-ray showed
a bilateral interstitial-alveolar pneumonia and Blood gas analysis
(BGA) in room air highlighted a severe respiratory failure (pO2 46
mmHg, pH 7.41). Due to clinical and biohumoral worsening (stable CRP at 24 mg/dL), tocilizumab (800mg) was performed after
acquiring patient’s informed consensus. In the evening, after 96
hours of hospitalization, the patient presented a clear hyposthenia
/ hemiparesis of the right hemisome whit hyperreflexia, confusion
and slowed speech
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
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Idiopathic systemic capillary leak syndrome also known as
Clarkson’s disease is a potentially fatal disorder. Prompt institution
of appropriate therapy as outlined here can reduce the
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Pancreatic cancer remains as one of the most aggressive and deadliest of cancers largely due to formidable challenges in diagnosis and therapy. Consensus standard treatment for patients with nonmetastatic Pancreatic Cancer (PC) incorporates possible neoadjuvant chemotherapy with timely surgical resection and adjuvant chemotherapy. However, despite all the sophistication of modern radiological and endoscopic techniques, the decision regarding operability is often only made intra-operatively, therefore subjecting a patient to unnecessary surgical intervention, and postponing the possibility of starting early chemotherapy.
Research Progress in Chronic Lymphocytic LeukemiaAnonIshanvi
Cancer is an uncontrolled division of cell occurs due to genetic alterations and mutation. Chronic lymphocytic leukemia is the heterogeneous lymphocytic malignancy worldwide that leads to death.
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Carriers of the BRCA-1/2 mutation have increased and variable risks of Breast Cancer (BC) and ovarian cancer and vary or are modified by common genetic variants and their incidence genetic testing and risk-reducing surgery has increased, they should receive advice and evaluation by the physician with experience in genetics.
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The impact of the SARS-CoV-2 infection in all areas at the national and international level is undeniable, the aftermath of this “tornado” will be visible for a long time, even when the infection manages to be controlled. Two aspects of great interest to those of us who work in the area of oncology must be considered: on the one hand, the need to contain and control the devastating effects of the disease forced a reorganization in the operation of services, giving priority to COVID, conversion of medical units to hospitals COVID created a high-risk scenario for patients with other types of pathologies; This reorganization includes the allocation of large amounts of budget to COVID areas to the detriment of patients with other types of equally serious diseases - such as cancer, among others - who cannot wait for care in better times.
Meta-Analysis of Lateral Lymph Node Dissection for Mid Lower Rectal Cancer: I...AnonIshanvi
Presence of lateral lymph node metastasis in rectal cancer was originally reported in the 1950s.Lateral lymph node metastasis occurs in 15 to 20% of patients with locally advanced low rectal cancer which escalates likelihood of local recurrence and reduced survival following neoadjuvant chemoradiotherapy (nCRT) and Total Mesolectal Excision (TME).
Analyzing Speech Outcomes in Hemiglossectomy Patients Using Telecare PlatformAnonIshanvi
Dysarthria is a common postoperative sequela of glossectomy and can greatly impact daily function and Quality of Life (QOL). It is important to study the anatomic and physiological factors that influence speech function, even with the challenges of conducting clinical research during the COVID pandemic. Therefore, our study aims to 1) display the feasibility of using a telecare platform to conduct clinical research; 2) analyze speech outcomes of patients who underwent hemiglossectomy with radial forearm free flap (RFFF) tongue reconstruction.
Uterine Myoma, Risk Factor and Pathophysiology: A Review ArticleAnonIshanvi
Uterine myoma is a benign neoplasm composed of uterine smooth muscle and connective tissue that supports it and is often referred to as fibromyoma, leiomyoma, fibroids. Can be single or multiple and reach large sizes (100 pounds). It has a tough consistency, with a clear cap boundary so that it can be removed from the surroundings. Uterine myoma, also known as leiomyoma or fibroid is a benign tumor that is often found in women of reproductive age (20-25%). At age> 35 years the incidence is higher, that is, closer to 40%. The high incidence of uterine myomas between the ages of 35 and the ages of 50 indicates a relationship between the incidence of uterine myomas and estrogen.
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defined as “a malignant, invasive embryonal tumor of the cerebellum with preferential manifestation in children, predominantly
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IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
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RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
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Hypoparathyroidism - Not Only after StrumectomyUnusual Presentations of the Rare Disease
1. Clinics ofOncology
ISSN: 2640-1037
Case Report
Hypoparathyroidism – NotOnly after Strumectomy Unusual
Presentations of the RareDisease
Misiorowski W*
, Szatańska AL and Zgliczyński W
Department of Endocrinology, Medical Center for Postgraduate Education, WarsawBielanski Hospital, Ceglowska 80 str. 01-809
Warsaw, Poland
1. Abstract
Hypoparathyroidism (HypoPT) is an endocrine disease with low calcium and inappropriately low
(insufficient) circulating PTH levels. HypoPT may have an autoimmune pathogenesis, however,
the most common causes of chronic HypoPT are iatrogenic: mostly thyroid or parathyroid surgery.
Much less frequently HypoPT is caused by an extensiveoncological procedures: external neck ir-
radiation, e.g. in lymphoma or neck surgery e.g. because of larynx or upper throat cancer. Tetany
is the most famous, spectacular symptom associated with hypoparathyroidism, however it occurs
only in about 70% of cases of this rare disease and its occurrence is determined not so much by
the absolute size of the fall in serum calcium, if the speed at which the decline occurred. Therefore
tetany can easily occur as a result of a even mild hypocalcemia immediately after thyroid surgery.
However in post-laryngectomy or post-radiotherapy damage of the parathyroid glands occurs
gradually, initiallymanifestedonly as decreased PTHreserve in response to thedecreasingserum cal-
cium, eventualy leading to hypocalcemia. Such chronic hypocalcemia is often well tolerated, and
difficult to identify,which implies the need for systematic monitoring of calcemia, as well as the
performance of diagnostic tests with the slightest clinical suspicion of hypoparathyroidism.
2. Introduction
Hypoparathyroidism (HypoPT) is an endocrine disease with low
calcium and inappropriately low (insufficient) circulating PTH
levels. It is a rare condition, designated as an orphan disease
by the European Commission in January2014(EU/3/13/1210)
(http://www.ema.europa.eu/ema/index.jsp?curlZpages/medi-
cines/human/orphans/2014/01/human_orphan_001301.
jsp&midZWC0b01ac058001d12b) and the only major endocrine
condition today, where the hormonal insufficiency is not treated
commonly by substitution of the missing hormone (PTH) [1, 2].
HypoPT may have an autoimmune pathogenesis, and the cause
is a mutation in the autoimmune regulator of endocrine function
(AIRE) gene. There are also many other rare genetic conditions
that can cause HypoPT either as part of a syndrome (e.g. Di-
George syndrome) or as an isolated endocrinopathy [3-6]. How-
ever, the most common causes of chronic HypoPT are iatrogenic:
mostly thyroid or parathyroid surgery[3,4,7,8,9]
Much less frequently HypoPT is caused by an extensive onco-
logical procedures: external neck irradiation, e.g. in lymphoma or
neck surgery e.g. because of larynx or upper throat cancer. In this
particular cases, the oncological nature of the disease itself fo-
cuses on the most of the attention (as well the patient as doctors),
which often results in neglect of other health hazards. Moreover,
potentially poor prognosis, poor quality of life, and short sur-
vival time additionally mask the problem. However, in individual
patients cured from a cancer, unrecognized hypoparathyroidism
can in the long term, significantly affect the health and quality of
life [10].
Tetany is the most famous, spectacular symptom associated with
hypoparathyroidism. It is often forgotten that it occurs only in
about 70% of cases of this rare disease and its occurrence is de-
termined not so much by the absolute size of the fall in serum
calcium, if the speed at which the decline occurred. Therefore
tetany can easily occur as a result of a even mild hypocalcemia
immediately after thyroid surgery, but may never occur in auto-
immune HypoPT or after neck irradiation.
3. Case 1
54-year-old male, at the age of 26 years treated for non-Hodgkin
*Corresponding Author (s): Waldemar Misiorowski, Department of Endocrinology,
Medical Center for Postgraduate Education, WarsawBielanski Hospital, Ceglowska 80
str. 01-809 Warsaw, Poland, E-mail: w_misiorowski@wp.pl
clinicsofoncology.com
Citation: Misiorowski W, Hypoparathyroidism – Not Only after StrumectomyUnusual Presentations of the
Rare Disease. Clinics of Oncology. 2019; 1(9): 1-5.
Volume 2 Issue 2- 2019
Received Date: 06 Nov 2019
Accepted Date: 05 Dec 2019
Published Date: 10 Dec 2019
3. Volume 2 Issue 2-2019 Case Report
clinicsofoncology.com 3
5. Discussion
Hypocalcemia can present as an asymptomatic laboratory find-
ing or as a severe, life-threatening condition. In the setting of
acute hypocalcemia, rapid treatment may be necessary. In con-
trast, chronic hypocalcemia may be well tolerated, but treatment
is necessary to prevent long-term complications. Patients with
long-lasting, unrecognized HypoPT may develop neurological
complications, including calcifications of the basal ganglia and
other areas of the brain and extrapyramidal symptoms [11].
Grand mal, petit mal, or focal seizures have been described.
Increased intracranial pressure and papilledema may be pres-
ent [12,13]. If the patient has pre-existing subclinical epilepsy,
hypocalcemia may lower the excitation threshold for seizures
[12]. In some cases of chronic hypoparathyroidism, psychoses
and organic brain syndrome have been noted [14]. Delayed de-
velopment in children and the deterioration of intellectual and
cognitive skills in adults, up tofull dementia, istypical [15,16]. In
the elderly population, disorientation or confusion also may be
manifestations of hypocalcemia. Subnormal IQ, and poor cog-
nitive function could also be a component of a syndrome that
includes hypoparathyroidism as one of its features [15,16]. This
is critically important to consider in young patients being evalu-
ated for the condition. . Treatment of the hypocalcemia may im-
prove mental functioning and personality, but amelioration of
psychiatric symptoms is inconsistent. The typical tetany is rare,
but changes in smooth muscle function with low serum levels
of calcium may take the unusual form of dysphagia, abdominal
pain, biliary colic, functional disturbances in urination or bron-
chospasm with wheezing, and dyspnea. Patients complain of
constant or easy fatigue, emotional lability or anxiety. Typical is
rapidly progressive subcapsular cataract [14].
Thyroid surgery is associated with hypocalcemia, presumably
due to surgical disruption or vascular compromise of the para-
thyroid glands [9]. Transient hypocalcemia is observed in 16-
55% of total thyroidectomy cases. One group recently reported
that of the 50% of patients who developed post-operative hypo-
calcemia, hypoparathyroidism persisted beyond one month in
38% [16]. In another retrospective study, transient hypocalcemia
was observed in 35% of patients undergoing total thyroidectomy,
3% had chronic hypocalcemia 6 months post-operatively, and
1.4% had permanent hypoparathyroidism 2 years post-opera-
tively[17]. The type of surgery performed is associated with the
risk of developing hypocalcemia. For example, risk of hypocal-
cemia is higher after total thyroidectomy with node dissection
[9,18]. Transient hypocalcemia was observed more frequently
after thyroidectomy for Graves’ disease than for nontoxic mul-
tinodular goiter, although incidence of permanent hypoparathy-
roidism was not different between groups[19].
In patients undergoing laryngectomy or pharyngolaryngectomy
for laryngeal carcinoma, complete or partial resection of the thy-
roid gland is often necessary. In least advanced cancers, at least
mobilization of the thyroid gland with possible vascular disrup-
tion or ligation of the inferior thyroid artery or its branches is
performed. That explain, why hypocalcemia is commonly ob-
served after these procedures, however it is rarely recalled and
unacknowledged issue. Basheeth et al. reported an incidence of
biochemical hypocalcemia of 43% in laryngectomy patients ob-
served up to the end of the first week after procedure; however,
symptomatic hypocalcemia concerned only 15% of cases [20].
Concomitant bilateral neck dissection, previous treatment with
radiotherapy and most probably also advanced T-classification
of a tumor were significantly predictive of its appearance. What
is interesting, no correlation between hypocalcemia and the ex-
tent of neither thyroidectomy, pharyngectomy, nor the presence
of preoperative tracheostomy has been stated [20]. Especially
little it is known about persistent hypocalcemia and parathyroid
dysfunction in prospect of a few or even many years after sur-
gery. Lo Galbo et al. reported 7.3% of persistent hypocalcaemia
at 24 months after intervention in laryngectomy patients [21].
On the other hand, Thorp et el, in series of patients with larynge-
al or pharyngolaryngeal cancer who lived 5 years after treatment,
reported an incidence of hypoparathryroidism (with hypocalce-
mia or not) of over 60% in the subgroup subjected only to sur-
gery [22]. It was shown that hypoparathyroidism occurred more
commonly in patients who received radiotherapy either alone or
in combination with surgery than in patients treated solely with
surgery.
The irradiation of the neck region is a well-documented factor
of delayed hypothyroidism, however the influence of radiother-
apy on parathyroid glands is a poorly known phenomenon and
seems to be extremely rare complication following parathyroid
irradiation. The four parathyroid glands receive radiation during
radiotherapy of neoplasm of the head and neck including lym-
phoma, Hodgkin’s disease, and cancer of the thyroid. Because of
their localization, parathyroid glands frequently receive radia-
tion from 131I therapy for thyroid disease. However, parathyroid
chief cells have very high radioresistance to necrosis or loss of
function. Immediate radiation destruction or ablation of the
chief cells to cause acute, symptomatic hypoparathyroidism is
exceedingly rare, in fact so rarely documented, that it may not
occur [23,24].
Delayed postradiation hypoparathyroidism also seems to be
rare. Eipe at al. reported one patient with low serum calcium
tetany diagnosed 5 month after 131I therapy with 15.7 mCi [25].
In Glazbrook’s review of seven patients, four have received low-
dose 131I therapy, two had received external beam conventional
radiotherapy, and one received both treatments [26]. The two
4. Volume 2 Issue 2-2019 Case Report
clinicsofoncology.com 4
who received external beam therapy had metastatic cancer in the
neck. The patients who received 131I therapy also received thy-
roidectomies. Regardless of the fact that probability of unequivo-
cal postradiation delayed parathyroid damage seems to be rare,
the actual number of affected patients may be even smaller - due
to natural course of underlying disease and short survivaltime.
6. Conclusions
Similarly to the autoimmune disease of parathyroids, in post-
laryngectomy or post-radiotherapy damage of the parathyroid
glands occurs gradually, initially manifested only as decreased
PTH reserve in response to the decreasing serum calcium,even-
tually leading to hypocalcemia [7,27]. Such chronic hypocal-
cemia is often well tolerated, and difficult to identify. Despite
increasing knowledge about the phenomenon of autoimmune,
postoperative or postradiation hypocalcemia, there is still little
data concerning long-term follow-up of patients at risk. In lit-
erature, cases of post-thyroidectomy hypoparathyroidism diag-
nosed even as many as 40 years after surgery are described [28].
To our knowledge, described here cases are the first to be pre-
sented after such a long time in post-laryngectomy or post-ra-
diotherapy. It may indicate that other such patients are as much
likely to develop this rare complication, regardless of the period
of time elapsing from the treatment, which implies the need for
systematic monitoring of calcemia, as well as the performance of
diagnostic tests with the slightest clinical suspicion of hypopara-
thyroidism.
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