Incidencia de hipocalcemia e hipoparatiroidismo en cirugías de cuello / Hypocalcaemia and hypoparathyroidism' incidence in neck surgeries

INTRODUCCIÓN: el hipoparatiroidismo es la alteración causada por hipofunción de las glándulas paratiroides y la causa más común es la posquirúrgica. OBJETIVO: conocer la incidencia de hipocalcemia dentro de las 72 horas del postoperatorio y de hipoparatiroidismo permanente de tiroidectomías en nueve años. SUJETOS Y MÉTODO: estudio observacional, descriptivo y retrospectivo de pacientes con tiroidectomías entre enero de 2011 y diciembre de 2019 en el Hospital de Clínicas. Se dividió la muestra por grupos etarios, se consideró hipocalcemia a valores ≤8,5 mg/dl e hipoparatiroidismo permanente cuando persistían por lo menos un año luego de cirugía. RESULTADOS: fueron 202 pacientes, 182 mujeres y 20 hombres, media de edad ± ES para mujeres 47.3±1.2 años y para hombres 55.1±3.4. El 61,5% presentó hipocalcemia en las primeras 72 horas del postoperatorio: 60,2% de mujeres y 71,4% de hombres (p=0.42). El 79% fueron hipocalcemias asintomáticas, 7,5% tuvo síntomas y 13,5% sin datos. El signo de Trousseau fue negativo 68% y positivo en 9%. Respecto a la patología hubo 107 resultados benignos, 94 malignos. CONCLUSIONES: el 90% fueron mujeres, 6 de cada 10 presentaron hipocalcemia en las primeras 72hs, en la gran mayoría fueron asintomáticas y tuvieron signo de Trousseau negativo. No hubo correlación entre hipocalcemia con edad, sexo, duración o tiempo de la cirugía, ni resultado de patología. La incidencia de hipoparatiroidismo transitorio fue 75,7% y permanente 7,3%. Cuando no hubo hipoparatiroidismo transitorio tampoco hubo hipoparatiroidismo permanente.

INTRODUCTION: hypoparathyroidism is the alteration caused by hypofunction of the parathyroid glands and the most common cause is post-surgery. OBJECTIVE: to know the incidence of hypocalcaemia within 72 hours of the postoperative period and of permanent hypoparathyroidism of thyroidectomies in nine years. SUBJECTS AND METHOD: observational, descriptive and retrospective study of patients with thyroidectomies between January 2011 and December 2019 at Clinical's Hospital. The sample was divided by age groups, hypocalcemia was considered at values ≤8.5 mg/dl and permanent hypoparathyroidism when they persisted for at least one year after surgery. RESULTS: there were 202 patients, 182 women and 20 men, mean age ± SE for women 47.3±1.2 years and for men 55.1±3.4. 61.5% presented hypocalcaemia in the first 72 hours after surgery: 60.2% of women and 71.4% of men (p=0.42). 79% were asymptomatic hypocalcemia, 7.5% had symptoms and 13.5% without data. Trousseau's sign was negative in 68% and positive in 9%. Regarding the pathology, there were 107 benign results, 94 malignant. CONCLUSIONS: 90% were women, 6 out of 10 presented hypocalcemia in the first 72 hours, the vast majority were asymptomatic and had a negative Trousseau sign. There was no correlation between hypocalcaemia with age, sex, duration or time of surgery, or pathology result. The incidence of transient hypoparathyroidism was 75.7% and permanent 7.3%. When there was no transient hypoparathyroidism, there was also no permanent hypoparathyroidism.

Tratamiento de hipoparatiroidismo con parathormona recombinante humana [rhPTH(1-84)] / Hypoparathyroidism treated with recombinant human parathyroid hormone [rhPTH(1-84)]

El hipoparatiroidismo (hipoPTH) es una enfermedad infrecuente caracterizada por hipocalcemia y niveles inapropiadamente bajos o ausentes de parathormona. Presentamos el caso de un hombre de 25 años, deportista de alto rendimiento, con antecedente de hipoPTH secundario a tiroidectomía total dos años antes por cáncer papilar multifocal bilateral tiroideo, estadificado como T3 N1b M0, derivado por hipocalcemia sintomática. Presentaba calcemias promedio de 7mg%, síntomas de hipocalcemia en reposo y múltiples internaciones. Inicialmente, se optimizó tratamiento convencional con aporte de calcio vía oral hasta 12g/día, vitamina D y calcitriol, sin mejoría clínica ni bioquímica. Se descartaron malabsorción y complicaciones crónicas de hipoPTH. Se evidenció a través de cuestionario de salud SF-36 disminución de la calidad de vida. Se indicó sustitución con parathormona recombinante humana [rhPTH(1-84)] 50μg/día subcutánea con posterior ascenso a 75μg y reducción progresiva de la medicación por vía oral. Actualmente se encuentra asintomático, sin requerimiento de calcio ni vitamina D, mantiene calcemias de 9mg%, realiza actividad deportiva y demuestra marcada mejoría en la calidad de vida según cuestionario SF-36 (36-Item Short Form Health Survey).

Hypoparathyroidism (HypoPT) is a rare disease characterized by low calcium and inappropriately low circulating parathormone levels. We present the case of a 25-year-old high-performance athlete male, with history of HypoPT after total thyroidectomy for papillary thyroid carcinoma (T3 N1b M0) two years before, who was referred to our clinic for symptomatic hypocalcemia. The patient reported serum calcium average levels of 7mg%, presented symptoms of hypocalcemia at rest and had multiple hospital admissions. First, standard treatment was optimized by calcium supplementation up to 12g/d and active vitamin D, not showing clinical or biochemical improvement. Malabsorption and complications of chronic HypoPT were ruled out. The 36-Item Short Form Health Survey (SF-36) demonstrated an impaired quality of life (QoL). Full-length recombinant human parathyroid hormone [rhPTH(1-84)] therapy was started with 50μg/d subcutaneous, and later adjusted to 75μg/d and the oral treatment gradually decreased. Currently, he is asymptomatic, with serum calcium levels above 9mg%, without receiving oral medication. He performs sports activity and shows marked improvement in quality of life according to SF-36 questionnaire.

Hipoparatiroidismo y calcificaciones cerebrales: reporte de caso / Hypoparathyroidism and brain calcifications: a case report

Introducción. El hipoparatiroidismo es una enfermedad caracterizada por la ausencia o concentraciones inadecuadamente bajas de hormona paratiroidea (PTH), que conduce a hipocalcemia, hiperfosfatemia y excreción fraccional elevada de calcio en la orina. Las calcificaciones del sistema nervioso central son un hallazgo frecuente en estos pacientes. Caso clínico. Mujer de 56 años con antecedente de hipotiroidismo, que ingresó por un cuadro de 6 días de evolución caracterizado por astenia, parestesias periorales y movimientos anormales de manos y pies. Las pruebas de laboratorio demostraron hipocalcemia, hiperfosfatemia y niveles bajos de hormona paratiroidea. Se realizó una tomografía computarizada de cráneo que mostró áreas bilaterales y simétricas de calcificaciones en hemisferios cerebelosos, ganglios basales y corona radiata. No se evidenciaron trastornos en el metabolismo del cobre y hierro. Se estableció el diagnóstico del síndrome de Fahr secundario a hipoparatiroidismo y se inició tratamiento con suplementos de calcio y vitamina D con evolución satisfactoria. Discusión. El síndrome de Fahr es un trastorno neurológico caracterizado por el depósito anormal de calcio en áreas del cerebro que controlan la actividad motora. Se asocia a varias enfermedades, especialmente, hipoparatiroidismo. La suplementación con calcio y vitamina D con el objetivo de normalizar los niveles plasmáticos de estos cationes es el tratamiento convencional. (AU)

Introduction. Hypoparathyroidism is a disease characterized by absence or inappropriately low concentrations of circulating parathyroid hormone, leading to hypocalcaemia, hyperphosphataemia and elevated fractional excretion of calcium in the urine. Central nervous system calcifications are a common finding in these patients. Case report. 56-year-old woman with a history of hypothyroidism who was admitted for a 6-day course of illness characterized by asthenia, perioral paresthesias, and abnormal movements of the hands and feet. Laboratory tests showed hypocalcemia, hyperphosphatemia, and low parathyroid hormone levels. A cranial computed tomography was performed. It showed bilateral and symmetrical areas of calcifications in the cerebellar hemispheres, basal ganglia, and radiata crown. No disorders of copper or iron metabolism were evident. The diagnosis of Fahr syndrome secondary to hypoparathyroidism was established and treatment with calcium and vitamin D supplements was started with satisfactory evolution. Discussion. Fahr's syndrome is a neurological disorder associated with abnormal calcium deposition in areas of the brain that control motor activity. It is associated with various diseases, especially hypoparathyroidism. The conventional treatment is supplementation with calcium and vitamin D, with the aim of normalizing their plasma levels. (AU)

Displasia ectodérmica hipohidrótica autosómica dominante asociada a hipoparatiroidismo / Autosomal dominant hypohidrotic ectodermal dysplasia associated to hypoparathyroidism

RESUMEN Las displasias ectodérmicas constituyen alteraciones de los derivados embriológicos del ectodermo. Paciente adulta, con hipoparatiroidismo, llamó la atención por su fenotipo y fue remitida de la consulta de Neurología a la consulta Genética. Se diagnosticó una displasia ectodérmica hipohidrótica, de origen genético con herencia autosómica dominante, poco común para esta entidad. Se presenta este caso con el objetivo de describir las manifestaciones clínicas de esta alteración genética, las cuales nunca fueron objeto de interés médico resultando inadvertidas para su estudio y diagnóstico. Esta alteración se asocia a una condición patológica como el hipoparatiroidismo, en la literatura revisada no se encontraron reportes de la misma. La evaluación clínica de la paciente permitió hacer el diagnóstico y explicar muchos de los problemas para los cuales no existían respuestas, así como ofrecer un asesoramiento genético adecuado para ella y para sus familiares con riesgo de padecer una condición genética similar.

ABSTRACT Ectodermic dysplasias are alterations of the ectoderm embryologic derivatives. This is a case of an adult female patient with hypoparathyroidism, drawing attention due to her phenotype; she was remitted by the consultation of Neurology to the Genetic one. She was diagnosed a hypohidrotic ectodermal dysplasia, of genetic origin with autosomal dominant inheritance, what is very rare for this entity. The case is presented with the aim of describing the clinical manifestation of this genetic alteration that never drew medical interest and nobody diagnosed or studied. It is associated to a pathologic condition like hypothyroidism and was not reported in medical literature before. The clinical evaluation of the patient allowed arriving to the diagnostic and explaining many problems that were unexplained, and also offering the adequate genetic advice to her and her relatives likewise at risk of suffering a similar genetic condition.

Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Objective To present an update on the diagnosis and treatment of hypoparathyroidism based on the most recent scientific evidence. Materials and methods The Department of Bone and Mineral Metabolism of the Sociedade Brasileira de Endocrinologia e Metabologia (SBEM; Brazilian Society of Endocrinology and Metabolism) was invited to prepare a document following the rules set by the Guidelines Program of the Associação Médica Brasileira (AMB; Brazilian Medical Association). Relevant papers were retrieved from the databases MEDLINE/PubMed, LILACS, and SciELO, and the evidence derived from each article was classified into recommendation levels according to scientific strength and study type. Conclusion An update on the recent scientific literature addressing hypoparathyroidism is presented to serve as a basis for the diagnosis and treatment of this condition in Brazil.

Hypoparathyroidism and pseudohypoparathyroidism: etiology, laboratory features and complications

ABSTRACT Objectives To identify a clinical profile and laboratory findings of a cohort of hypoparathyroidism patients and determine the prevalence and predictors for renal abnormalities. Materials and methods Data from medical records of five different visits were obtained, focusing on therapeutic doses of calcium and vitamin D, on laboratory tests and renal ultrasonography (USG). Results Fifty-five patients were identified, 42 females and 13 males; mean age of 44.5 and average time of the disease of 11.2 years. The most frequent etiology was post-surgical. Levels of serum calcium and creatinine increased between the first and last visits (p < 0.001 and p < 0.05, respectively); and serum levels of phosphate decreased during the same period (p < 0.001). Out of the 55 patients, 40 had USG, and 10 (25%) presented with kidney calcifications. There was no significant difference in the amount of calcium and vitamin D doses among patients with kidney calcifications and others. No correlation between serum and urinary levels of calcium and the presence of calcification was found. Urinary calcium excretion in 24h was significantly higher in patients with kidney calcification (3.3 mg/kg/d) than in those without calcification (1.8 mg/kg/d) (p < 0.05). Conclusions The reduction of hypocalcemia and hyperphosphatemia suggest an effectiveness of the treatment, and the increase in serum creatinine demonstrates an impairment of renal function during follow-up. Kidney calcifications were prevalent in this cohort, and higher urinary calcium excretion, even if still within the normal range, was associated with development of calcification. These findings suggest that lower rates of urinary calcium excretion should be aimed for in the management of hypoparathyroidism.

Hipoparatiroidismo primario de presentación tardía asociado a patologías autoinmunes / Late onset primary hypoparathyroidism associated with autoimmune disorders

Se presenta una paciente que, en la sexta década de su vida, debuta con episodios de espasmo carpopedal espontáneo. Los valores bajos de calcemia (6,1 mg/dl) y de PTH (8 pg/ml) confirmaron el diagnóstico de hipoparatiroidismo. No había sido sometida a cirugías de cuello ni radioterapia. No existían antecedentes familiares vinculantes. Durante 11 años de seguimiento, la paciente presenta asociación con otras patologías que permiten sospechar la etiología autoinmune del hipoparatiroidismo: candidiasis de piel y uñas, hipotiroidismo por tiroiditis de Hashimoto, penfigoide y psoriasis. Finalmente fallece por una neumonía adquirida en la comunidad, complicada. (AU)

A patient who develops hypoparathyroidism during her sixth decade of life is reported. It was detected due to spontaneous carpopedal spasms. Low calcium (6.1 mg/dl) and PTH (8 pg/ml) levels confirmed the diagnosis. She had not undergone neck surgery or irradiation. There was no relevant family history. Throughout the 11 years follow up she presented association of other pathologies that allow the suspicion of autoimmune etiology of hypoparathyroidism: candidiasis of skin and nails, autoimmune thyroiditis, pemphigoid and psoriasis. She eventually died of complicated community-acquired pneumonia. (AU)

Postoperative calcium levels as a diagnostic measure for hypoparathyroidism after total thyroidectomy

ObjectiveThe aim of the present study was to identify a fast, efficient and low-cost method to diagnose hypoparathyroidism after total thyroidectomy.Materials and methodsOne hundred and forty medical records, which contained patients’ clinical and laboratory data, were retrospectively analyzed. Patient parathyroid hormone values, which were obtained immediately following operation, were compared with their ionized calcium levels the morning after surgery. This comparison was used to examine the correlation between the two variables in predicting hypoparathyroidism because measuring calcium levels is low-cost and more available in the hospitals compared to measuring parathormone (PTH) levels.ResultsThere was a positive and statistically significant correlation between PTH and ionized calcium values (Pearson correlation coefficient, r = 0.456; p < 0.0001). The values of first postoperative day ionized calcium levels (stratified by the 1.10 mmol/l cut-off value) were tested as a diagnostic measure for hypoparathyroidism, and a PTH < 15 pg/mL obtained immediately following operation served as a reference. This analysis showed that ionized calcium levels measured on the first postoperative day had a sensitivity of 45.6% (95% CI 30.9-61.0%), a specificity of 88.9% (95% CI 80.5-94.5%) and an accuracy of 76.7% (95% CI 68.7-83.5%) as a diagnostic measure for hypoparathyroidism.ConclusionIn conclusion, we demonstrated that patients who had high ionized calcium levels on the first postoperative day also had high PTH levels immediately following operation and, therefore, they had lower rates of hypoparathyroidism.

Postoperative Complications of Thyroid Cancer in a Single Center Experience

The aim of this study was to investigate the complications following surgical treatment of thyroid cancer and the association between the extent of surgery and complication rates. A total of 2,636 patients who underwent surgery due to thyroid cancer were retrospectively reviewed to identify surgical complications. Complication rates were assessed according to the extent of surgery, which was classified as follows; less-than-total thyroidectomy with central compartment node dissection (CCND) (Group I, n=636), total thyroidectomy with CCND (Group II, n=1,390), total thyroidectomy plus ipsilateral neck dissection (Group III, n=513), and total thyroidectomy plus bilateral neck dissection (Group IV, n=97). The most common surgical complication was symptomatic hypoparathyroidism, of which 28.4% of cases were transient and 0.3% permanent. The other surgical complications included vocal cord palsy (0.7% transient, and 0.2% permanent), hematoma (0.5%), seroma (4.7%), chyle fistula (1.8%), and Horner's syndrome (0.2%). The complication rates increased significantly with increasing the extent of surgery from Group I to Group IV. The more extensive surgery makes more complications, such as hypoparathyroidism, seroma, and others.

Paratireóides: estrutura, funções e patologia / Parathyroid glands: structure, functions and pathology

Os autores tecem considerações sobre a estrutura e funções normais das glândulas paratireóides como introdução à patologia e as repercussões clinico - patológicas tanto do excesso como da redução do paratormônio. Maior ênfase é dedicada ao hiperparatireoidismo primário quanto às causas, a fisiopatologia das alterações, os aspectos anatomopatológicos macro e microscópicos das lesões e sua patogenia, na "Osteite fibrocistica" ou "doença de von Recklinghausen dos ossos" com a correlação aos aspectos radiográficos. Apresentam caso de paciente, cuja história clinica demonstra as dificuldades encontradas para o diagnóstico da doença. Referem-se ainda às alterações e patogenia das formas de hiperparatireoidismo secundário e terciário e ao hipoparatireoidismo.

The authors present a summary on the normal anatomy and function of the parathyroid glands as well as a brief review of clinical and pathological repercussions of higher and lower parathyroid hormone production. The emphasis is given on the causes, physiopathology, anatomy, macroscopy and microscopy of the lesions and their role in the genesis of fibrocystic osteitis, also known as Von Recklinhausen disease of the bones. Radiological correlation is also given. The authors show the challenges for the diagnosis in the same cases. We also write about secondary and tertiary hyperparathyroidism, as well as hypoparathyroidism.

Complicaciones de la cirugía tiroidea / Postoperative complications of thyroidectomy

En este artículo se revisan las complicaciones de la cirugía tiroidea con especial énfasis en la lesión de nervio recurrente, hipoparatiroidismo transitorio y permanente, sangrado post operatorio y la lesión de nervio laringeo superior. Se mencionan los factores de riesgo que predisponen a complicaciones quirúrgicas insistiendo en la necesidad de una técnica operatoria cuidadosa que extreme los cuidados en la hemostasia, realice una exacta localización y preservación de los nervios recurrentes y una correcta identificación del mayor número posible de glándulas paratiroides ejerciendo una manipulación depurada y cuidadosa de estas estructuras. El uso de drenajes en el lecho operatorio de la tiroidectomía es controvertido, razón por la cual se comentan los pro y contras del uso rutinario. Se concluye que la experiencia del cirujano y una técnica quirúrgica meticulosa son los factores más determinantes de la morbilidad de esta cirugía.

Polyglandular autoimmune syndrome-type I.

Polyglandular autoimmune syndrome type I is a rare disorder characterized by mucocutaneous candidiasis (MC), hypoparathyroidism (HP) and adrenal insufficiency , requiring regular follow up as the components of the syndrome appear at different age groups. We report a six and half year boy having this syndrome and presenting with MC, HP and ectodermal dystrophy.

Síndrome autoinmune poliglandular tipo II: reporte de un caso y revisión de la literatura / Autoinmune polyglandular syndrome type II: a case report and review of literature

El síndrome autoinmune poliglandular (SAP) corresponde a una infrecuente entidad clínica que se reconoce por el compromiso de dos o más glándulas endocrinas basados en mecanismos autoinmunes, siendo posible además la afectación de órganos no endocrinos por esta misma causa. Debido a esto último el término síndrome autoinmune "poliendocrino", antes utilizado frecuentemente, ya no es completamente aceptado para referirse a esta patología. Actualmente existen dos grupos clásicos (SAP tipo I y tipo II) los cuales se clasifican de acuerdo a la edad de presentación de la enfermedad, combinaciones características de órganos comprometidos y patrón hereditario, entre otros. Además se describen otros dos grupos de menor importancia clínica llamados SAP tipo III y IV. A continuación se presenta un caso clínico pediátrico de SAP tipo II diagnosticado en el Hospital Herminda Martín de Chillán y una revisión actualizada de la literatura correspondiente.

Etiología poco habitual del estado convulsivo en una niña de 11 meses / An unusual etiology of convulsive status in an 11-month female infant

RESUMEN Las convulsiones son un trastorno frecuente en pediatría y se producen en 3 menos 5 por ciento de los niños. Las causas son diversas y entre ellas se hallan las deorden metabólico. Presentamos una paciente de 11 meses, derivada de Santa Rosa, La Pampa, por estadoconvulsivo en estudio. Ingresó medicada con tresanticonvulsivantes y ceftriaxona más aciclovir, conelectroencefalograma y resonancia magnética decerebro normales. Al examen físico presentaba hipoplasiade esmalte dental, palidez y ligera hipertoníade miembros inferiores. Los exámenes de laboratorioal ingreso demostraron anemia normocíticanormocrómica, hipoglucemia, hipocalcemia, hiperfosfatemiay niveles bajos de PTH. Ecografía cerebral:calcificaciones talámicas bilaterales y electrocardiogramacon QT prolongado. Con diagnóstico de hipoparatiroidismo primario, se inició tratamientocon gluconato de calcio endovenoso, carbonato decalcio como quelante del fósforo y 1, 25 dihidroxicolecalciferol(calcitriol), 25 mcg/día. Se realizaronestudios para detectar otras deficiencias glandulares.Queremos destacar la importancia de recordarestas causas infrecuentes de síndrome convulsivopara instaurar un tratamiento precoz y así evitarcomplicaciones y secuelas.Palabras clave: hipoparatiroidismo, convulsiones

Cultivo primario e inmortalización de células de paratiroides para trasplante celular, en hipoparatiroidismo quirúrgico / Primary culture and immortalization of parathyroid cells for cell transplantation, in surgical hypoparathyroidism

El hipoparatiroidismo permanente ocurre después de tireidectomía (0,2-4 por ciento) o de cirugía paratiroidea. Lamentablemente el autotransplante no es 100 por ciento efectivo para prevención, y los pacientes deben recibir suplementación de vitamina D y calcio de por vida, con un costoso y a veces difícil manejo médico. Poca experiencia hay a nivel mundial de alotrasplantes paratiroideos en humanos. Un grupo de investigadores logró un período de sobrevida del injerto de 1 año en 8 pacientes, pero sin consignar los requerimientos de calcio y vitamina D. La dificultad de esta terapia es el rechazo por aloinmunización, y el establecimiento de cultivos primarios duraderos que permita conseguir una masa de células suficiente para el trasplante. Se ha logrado mantener cultivos, y función endocrina de ellos, por 60 días máximo. Nuestro objetivo es modificar y optimizar los cultivos primarios de paratiroides humana para: a)Obtener una línea continua de células paratiroideas, b)caracterizar la línea en cuanto a función endocrina, y c)disminuir la antigenicidad, como fuente futura de trasplante celular. La serie presentada incluye 5 pacientes intervenidas quirúrgicamente por hiperparatiroidismo primario, con diagnóstico definitivo de adenoma paratiroideo. Las muestras fueron sometidas a digestión enzimática y disgregación mecánica, cultivándose finalmente en placas de Petri a 37 °C. Resultados: Todos los cultivos primario fueron efectivos, con morfología típica a la microscopia. El primer cultivo creció y produjo PTH, pero no sobrevivió a contaminación del medio de cultivo. Los otros 4 están aún en período de expansión (crecimiento y multiplicación) con 150,60,40 y 35 días de cultivo. La función endocrina de las células en cultivo fue estudiada midiendo PTH en el medio de cultivo. Se obtuvo una producción promedio de 521,6 pg/ml en 24 horas (224-730 pg/ml). Todos los cultivos fueron positivos para esta medición.

Aortoarteritis presenting with hypoparathyroidism.

Clinical manifestations of aortoarteritis (Takayasu's arteritis) are varied, depending on the involved segment of the aorta and its branches. A case of a young Indian woman with aortoarteritis presenting primarily with hypoparathyroidism is reported. Aortogram showed total occlusion of the arch arteries. To the best of our knowledge, the occurrence of hypoparathyroidism in aortoarteritis has not been reported. Possible mechanisms of such an involvement are discussed.

Hypocalcemia due to hypoparathyroidism in Beta thalassemia major patients

This is a retrospective analysis of case records of b-thalassemia major patients who developed hypoparathyroidism [HPT]. The objective of this study was to assess the prevalence of hypocalcemia and hypoparathyroidism in b-thalassemia major patients being followed at King Khalid University Hospital [KKUH], Riyadh, Saudi Arabia. Patients and Diagnosis was based on low serum calcium [S/Ca], high serum phosphate [Po4], normal serum magnesium and alkaline phosphatase, and low serum parathyroid hormone levels. Other parameters analyzed included age, sex, serum ferritin levels, age of onset of HPT, any symptoms of hypocalcemia, and presence of other complications in these patients. Out of 40 patients, eight [20%] were diagnosed to have HPT. The mean age at diagnosis was 13.6 years [range 11-16 years], mean serum calcium was 1.88 mmol/L [range 1.58-2.04], mean serum ferritin was 7490 micro g/L [range 2000-23,064] and mean serum phosphate was 1.88 mmol/L [range 1.50-2.73]. Serum parathyroid hormone [PTH] levels were low in most of the patients. Only two patients [25%] had mild symptoms of hypocalcemia. Growth retardation was present in all patients, while four patients had liver dysfunction, two had diabetes mellitus and two had cardiac dysfunction. HPT due to iron overload may develop in a significant number of thalassemia major patients, especially when chelation therapy is not optimal, therefore, all thalassemics should be carefully watched for this complication from early in their second decade

Resultados del tratamiento quirúrgico del cáncer tiroides / Results of the surgical treatment of thyroid cancer

En el Servicio de Cirugía del Hospital Regional de Talca, se han diagnosticado y tratado 32 pacientes con cáncer de tiroides, entre los años 1974 y 1996, todos confirmados histológicamente. Se analizan las características clínicas, el tipo histológico, la cirugía empleada y los resultados en cuanto a sobrevida. El 87,5 por ciento de los casos correspondió a mujeres. En el 62,5 por ciento fueron bocios uninodulares. Casi el 47 por ciento de los pacientes tenían más de 1 año de evolución previo al diagnóstico. El 60 por ciento se presentaron en etapa clínica I. Hubo 87,5 por ciento de carcinomas diferenciados y 6,25 por ciento de medulares y anaplásicos, cada uno por igual. El procedimiento quirúrgico utilizado con más frecuencia fue la tiroidectomía total. No hubo mortalidad operatoria. 5 pacientes fallecieron por cáncer de tiroides, entre ellos todos los anaplásicos. Siete pacientes se perdieron del control y finalmente 15 sobreviven libres de enfermedad