The importance of the ligation of the inferior thyroid artery in parathyroid function after subtotal thyroidectomy

We prospectively studied the effects of the ligation of the inferior thyroid artery (ITA) on postoperative hypoparathyroidism in 48 patients who underwent functional subtotal thyroidectomy. Patients were randomized into two groups: A, with bilateral ligation of the ITA and B, without ligation of the ITA. Parathyroid function was checked preoperatively and after surgery by clinical examination and measurement of total calcium, intact PTH, urinary calcium, and AMPc. RESULTS: A significant incidence of postoperative hypocalcemia occurred: 17 percent in group A and 13 percent in B on the 4th postoperative day. Six months later, the incidence was 5 percent in Group A and 0 percent in Group B. These differences were not statistically significant between the two groups, and neither were any of the other clinical and laboratory observations. CONCLUSION: The ligation of the ITA was not an important causal factor for the occurrence of postoperative hypocalcemia after subtotal thyroidectomy

Metabolic factors for urolithiasis in acromegalic patients

Acromegaly is associated with metabolic disturbances of calcium and phosphorus which can also contribute to renal lithogenesis. In order to characterize these disturbances more precisely, an oral calcium load test was performed on 14 active acromegalic patients. Serum and urinary levels of calcium, phosphorus, uric acid, creatinine and urinary cyclic AMP were determined. Of the 14 patients, 5 (36%) presented hypercalciuria, 5 (36%) presented intestinal calciumhyperabsorption and 6 (43%) had uric acid hyperexcretion. Two patients (14%) presented nephrolithiasis. The medical records of 32 additional acromegalic patients with or without active disease were reviewed for a history of previous stones, which was observed in three cases (9.5%). The present data suggest that nephrolithiasis occurs more frequently among acromegalic patients because of the underlying metabolic disturbances of calcium presented by this population

Calciúria, sobrecarga de cálcio e AMP cíclico urinário na avaliaçäo de pacientes com litíase cálcica / Calciuria, calcium overload and urinary cyclic AMP in the evaluation of patients with calcic lithiasis

Para avaliar a participaçäo das paratiróides nos mecanismos fisiopatológicos de pacientes litiásicos hipercalciúricos, analisamos a excreçäo urinária de AMP cíclico (AMPc). Através de dosagens das calciúrias de 24 horas e da prova de sobrecarga oral de cálcio caracterizamos os pacientes em 3 grupos, ou seja: pacientes com hipercalciúria renal (HCaR); com hiperabsorçäo intestinal de cálcio (HAInt) e pacientes litiásicos sem alteraçäo do metabolismo do cálcio. A dosagem do AMPc total urinário nos pacientes com HCaR näo se mostrou aumentada (2,9 + ou - 0,2nmol/dl de filtrado glomerular, p >0,05), näo caracterizando, portanto, hiperparatiroidismo secundário. Esta observaçäo sugere que o paratormônio (PTH) näo participa no mecanismo fisiopatológico da HCaR, ou que a sensibilidade do método näo é suficiente para detectar discretas variaçös intra-ensaio. Portanto, o AMPc total urinário näo foi útil na discriminaçäo das hipercalciúrias. Entretanto, a calciúria de 24 horas e a prova de sobrecarga de cálcio se mostraram adequadas na diferenciaçäo dos estados hipercalciúricos, permitindo com isto abordagem terapêutica mais racional nos pacientes litiásicos com distúrbios metabólicos associados