An Overview of the Parathyroid - The Calcium-regulating Gland that Helps Keep Bones Healthy
The thyroid gland and parathyroid glands are a group of endocrine glands Juvenile Correctional Counselor» · How To Become a Hospital Interpreter». The parathyroid gland has a single responsibility in the endocrine system—to The parathyroid is located near your thyroid; however, their. WebMD's Thyroid Anatomy Page provides a detailed image of the thyroid as well as a definition and information related to the thyroid. Learn.
The thyroid hormone, parathyroid hormone and vitamin D associated hypertension
PTH regulates how much calcium is absorbed from your diet, how much calcium is excreted by your kidneys, and how much calcium is stored in your bones. PTH increases the formation of active vitamin D, and it is active vitamin D that increases intestinal calcium and phosphorus absorption.
Diseases and Disorders of the Parathyroid When the parathyroid releases too much or too little PTH, it adversely affects your body in a variety of ways.
Below are common diseases and disorders associated with the parathyroid glands: The most common disease of parathyroid glands is hyperparathyroidism, which is characterized by excess PTH hormone, regardless of calcium levels. In other words, the parathyroid glands continue to make large amounts of PTH even when the calcium level is normal, and they should not be making the hormone at all.
Hypoparathyroidism is the combination of symptoms due to inadequate parathyroid hormone production. PHPT is associated with increased incidence of hypertension. Lower prevalence of hypertension has been reported in Indian series on primary hyperparathyroidism [ Table 1 ].
Table 1 Open in a separate window Mechanism of hyperparathyroid hypertension Multiple factors contribute to parathyroid hypertension though the exact mechanism is still not clear. Serum calcium and intracellular calcium are important components that determine vascular tone in smooth muscles. Patients with hypertension and PHPT have commonly been shown to have an increased total peripheral resistance.
The proposed factors which have been held responsible for producing hypertension in patients with PHPT include activation of the rennin—angiotensin-aldosterone axis which produces vasoconstriction. The causality of the disorder and the reversibility of elevated blood pressure are not as clear-cut and concrete as in a patient with a classical endocrine hypertension. But because these disorders are far more common, they should be routinely sought and a practicing endocrinologist needs to be aware of the underlying mechanisms for the hypertension to be able to manage these patients more scientifically.
Footnotes Conflict of Interest: Kleen I, Danzi S. Thyroid disease and the heart. Cellular and molecular basis of deiodinase-regulated thyroid hormone signaling. Mechanisms of thyroid hormone receptor specific nuclear and extra nuclear actions. Uptake of thyroid hormone in neonatal rat cardiac myocytes. Thyroid hormone induced alteration in phospholamban protein expression: Translational implications of nongenomic actions of thyroid hormone initiated at its integrin receptor.
Am J Physiol Endocrinol Metab. Thyroid hormone and high blood pressure. Endocrine Mechanisms in Hypertension. Hypothyroidism as a cause of hypertension. Fommei E, Lervasi G.
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The role of thyroid hormone in blood pressure homeostasis: Evidence from short-term hypothyroidism in humans. J Clin Endocrinol Metab. Saito I, Saruta T. Hypertension in thyroid disorders. Endocrinol Metab Clin North Am. The thyroid and the heart. Re-evaluation of a possible high incidence of hypertension in hypothyroid patients. Effects of thyroid function on blood pressure: Recognition of hypothyroid hypertension. Danzi S, Klein I. Thyroid hormone and blood pressure regulation.
The lack of association between hypertension and hypothyroidism in a primary care setting. Nutritional and hormonal regulation of thyroid hormone deiodinases. Arterial stiffness is increased in subjects with hypothyroidism. Vascular and renal function in experimental thyroid disorders. Renal sodium and water handling in hypothyroid patients: The role of renal insufficiency. J Am Soc Nephrol. Klein I, Ojamaa K.
Thyroid hormone and the cardiovascular system. N Engl J Med. Thyroid hormones and renin secretion. Influence of short-time application of a low sodium diet on blood pressure in patients with hyperthyroidism or hypothyroidism during therapy. Gunasekera RD, Kuriyama H.
The influence of thyroid states upon responses of the rat aorta to catecholamines. The role of vasopressin in the impaired water excretion of myxoedema. Impact of obesity on hour ambulatory blood pressure and hypertension. Adolescent obesity is associated with high ambulatory blood pressure and increased carotid intimal medial thickness. Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives: The importance of hypertension in the geriatric population.
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The effect of age on blood pressure in hyperthyroidism. One day after surgery, it was 4. The resected part of the thyroid gland was normal on pathological examination.
The pathological examination of the resected PTH glands revealed nodular hyperplasia involving all glands confirming the PTH hyperplasia diagnosis. There were no complications during surgery.
However, the patient developed hypocalcemia that was normalized with calcium replacement therapy. Three days after the surgery, the patient presented with new symptoms of palpitation, anxiety, and hand tremors. A complete examination revealed mild, diffuse, non-tender goiter, and fine tremor, with stable vital signs. Serum thyroid function tests revealed that his TSH level was 0.
Technetiumm Tcm pertechnetate scintigraphy revealed generalized reduced tracer uptake in the thyroid gland, a finding that is compatible with thyroiditis Figure 4.
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Autoimmune markers were normal, including thyroglobulin Tg antibodies 2. However, inflammatory markers were elevated including C-reactive protein CRP 8. There was no clinical evidence of sepsis. The patient did not receive iodinated contrast agents; he did not receive lithium or amidarone nor medication that might have affected his thyroid function tests.
Other possible causes of thyroiditis have been ruled out, specifically, viral thyroiditis, bacterial thyroiditis, autoimmune thyroiditis, radiation thyroiditis, or drug-induced thyroiditis. Therefore, he was diagnosed with post-operative thyroiditis and given oral Bisoprolol.
He did not receive an antithyroid agent. There is increased background tracer activity in the salivary glands. These findings are compatible with thyroiditis. His condition improved over the following weeks. After 3 weeks, he made a complete recovery and had no persistent clinical or biochemical manifestations of thyroid disease.
The patient was examined in the clinic after 6 months.
At this time, he was clinically and biochemically euthyroid, with no indication of hypothyroidism. A definitive diagnosis of post-operative transient thyroiditis secondary due to manual manipulation of the thyroid gland during surgery was made. Discussion The incidence of post-operative thyroiditis is unknown as it is underreported. There are no data in the literature pertaining to complications of parathyroidectomy on the prevalence of post-operative transient thyroiditis.
This is likely because most patients are asymptomatic or have mild non-specific symptoms. InStang et al. The incidence of post-aspiration thyrotoxicosis was 0. Reported causes of iatrogenic thyrotoxicosis include use of medication that can affect the thyroid gland, such as lithium and amiodarone, recent radioiodine ablation, thyroid hormone replacement therapy, iodine excess, immunotherapy, external irradiation, and manipulation of the thyroid gland during surgery.
The exact mechanism of post-operative thyroiditis is unclear. In the past, hyperthyroidism arising after PTH surgery has been thought to be transient and relate to retraction of the thyroid gland for exposure during surgery.
InCarney et al. Noting that similar multifocal inflammatory changes usually were present in resected human thyroid lobes.
It is suggested that manipulation of the thyroid gland was sufficient to cause transient inflammatory reactions in both humans and dogs, which they termed as palpation thyroiditis and multifocal granulomatous folliculitis 5.
InWalfish et al.