RESUMO
Background Hypothyroidism, the commonest form of hormonal dysfunction, is due to thyroid hormone deficiency or its impaired activity. Homeostasis of the metabolism of minerals is regulated by thyroid hormones. If there is any disorder of the thyroid it will lead to disturbances of metabolism of minerals. Aim To study and compare serum calcium and serum phosphorus levels in patients of subclinical hypothyroidism and correlation of these parameters with thyroid-stimulating hormone (TSH) levels. Materials and methods This study included 70 patients with subclinical hypothyroidism, 70 patients with overt hypothyroidism, and 70 age- and sex-matched healthy controls. Thyroid profile (estimation of free triiodothyronine [FT3], free thyroxine [FT4], TSH) was done. In both cases and controls serum calcium and serum phosphorus levels were estimated. Results Serum calcium and phosphorus levels in patients of subclinical hypothyroidism was 8.75 ± 0.40 mg/dL and 3.80 ± 0.62 mg/dL, respectively. In patients with hypothyroidism it was 8.37 ± 0.52 mg/dL and 4.10 ± 0.75 mg/dL, respectively, and in controls it was 9.67 ± 0.97 mg/dL and 3.70 ± 0.71 mg/dL, respectively. Difference between these groups was statistically significant (p<0.05 ). Mean serum calcium and phosphorus for patients with TSH level <10 was 8.81 ± 0.33 mg/dL and 3.67 ± 0.60 mg/dL, respectively, and for TSH level >10 was 8.59 ± 0.51 mg/dL and 4.12 ± 0.54 mg/dL, respectively. The difference between both groups was statistically significant (p<0.05) for calcium, phosphorus . Conclusions In subclinical hypothyroidism serum calcium and serum phosphorus levels are significantly altered. Regular follow-up and estimating serum levels of these minerals in subclinical hypothyroidism patients should be done so it is beneficial to give mineral supplementations to prevent bone complications during the treatment of the disease.
RESUMO
BACKGROUND: Richter's hernia has an early misleading presentation with tendency to strangulation due to common lack of obstructive symptoms which may lead to delay in diagnosis and hence increased mortality. Rarely inguinal Richter's hernia may present with an uncommon complication of spontaneous fistula. The development of spontaneous faecal fistula secondary to incarcerated inguinal hernias is much rarer among the adult population as compared to the paediatric age group. Most of these fistula have been reported from developing countries like India and Nigeria and is usually the result of poverty, lack of knowledge, neglect, late presentation and lack of proper management. CASE PRESENTATION: A 62 years old male presented with chief complaints of multiple openings with faecal discharge in the right groin for last 20 days with no history of constipation, trauma, and urinary or other abdominal complaints. CT scan revealed a small gut loop communicating with anterior abdominal wall. Exploratory laparotomy revealed a loop of distal ileum adherent to the internal inguinal ring which was retrieved back into the abdominal cavity. There was perforation over the loop. Resection of the segment of ileum involved was done with ileo-ileal hand sewn anastomosis and the internal inguinal ring was closed from inside of the peritoneal cavity. The openings in the skin over the inguinal region were communicated with each other and laid open due to cellulitis of the area involved and pus discharge. CONCLUSION: Spontaneous faecal fistula in inguinal region following rupture of strangulated Richter's hernia especially in adults is very rare and can occur even in absence of obstructive symptoms. In presentation of any groin swelling, there is need for an early accurate diagnosis followed by prompt treatment. The delay in its diagnosis and management may result in this rare complication of spontaneous faecal fistula. This reflects the state of health care in the developing world and needs to be addressed by the concerned authorities.
