dihydrotachysterol and Thyroid-Neoplasms

This observational study analyzes Ca-P metabolism and its impact on bone mass accrual and density and the muscle-bone mass/mass relationships in male and female children and adolescents who were parathyroidectomized because of thyroid carcinoma. Two hundred and eight children and adolescents (119 girls and 89 boys) from Gomel city (Belarus) and its rural surroundings were referred to our institution after having undergone total thyroidectomy for the treatment of advanced papillary thyroid cancer. A subgroup of children with demonstrated primary hypoparathyroidism received dihydrotachysterol (AT-10) and/or Ca supplementation. Among routine procedures over a maximum follow-up period of 5 years (average 3.7 years, maximum 8 visits), whole-body scans were taken using dual energy X-ray absorptiometry (DXA) at each visit in order to determine whole-body bone mineral content (TBMC), projected "areal" bone mineral density (TBMD), total lean mass (TLM) and total fat mass (TFM). The average serum Ca, P and AP concentrations over the whole observation period were significantly different between the groups; however, TBMC z-scores for all studied children were statistically similar in all visits. In girls, no between-group differences in height- and weight-controlled TBMC and TBMD or the TBMC/TLM ratio were observed (ANCOVA) and supplementation exerted no effect on these data, suggesting that the total bone mass accrual was not impaired by PTH deficiency in the studied conditions. However, non-supplemented boys showed lower values of the TBMC/TLM ratio than girls, and supplementation normalized these values in direct correlation with the induced improvement in serum P availability to bone. Results indicate that the primary impairment in parathyroid function and bone metabolism indicators in the thyroidectomized children was unrelated to any measurable change in crude bone mass values. However, in boys this condition impaired the TBMC/TLM ratio in such a way that the administered supplementation could normalize it as a function of improved P availability. Girls' skeleton seemed to have been naturally protected against the negative metabolic effect of the studied condition. An estrogen-induced enhancement of the biomechanical impact of muscle contractions on bone mass and structure could not be excluded in this group.

Topics: Absorptiometry, Photon; Adolescent; Alkaline Phosphatase; Body Composition; Bone Density; Calcium; Carcinoma, Papillary; Child; Dihydrotachysterol; Female; Follow-Up Studies; Humans; Hypoparathyroidism; Male; Parathyroid Hormone; Phosphates; Republic of Belarus; Sex Factors; Thyroid Neoplasms; Thyroidectomy

Topics: Anti-Inflammatory Agents; Calcium; Carcinoma, Papillary; Diagnosis, Differential; Dihydrotachysterol; Drug Overdose; Female; Glucocorticoids; Hospitalization; Humans; Hypercalcemia; Hypoparathyroidism; Middle Aged; Postoperative Complications; Prednisone; Prognosis; Thyroid Neoplasms; Thyroidectomy; Thyroxine; Time Factors

This report describes a forty-seven-year-old female patient with a complex medical history. She was suffering from an unspecified interstitial lung disease, papillary thyroid carcinoma which had been treated, hypoparathyroidism after thyroidectomy for which she was receiving dihydrotachysterol and calcium, and atrial fibrillation and congestive heart failure as a result of mitral stenosis. Shortly after mitral valve replacement she developed a severe hypercalcemia (serum calcium 5.95 mmol/l) during a febrile illness. At that time anti-tuberculous agents were also being administered for presumed tuberculosis. The possible mechanisms for this severe elevation of the calcium level are discussed. Immobilization, while Paget's bone disease was present, and perhaps enhanced activation of dihydrotachysterol by rifampicin, could have led to increased calcium-release into the circulation. Continuous supplecation of calcium and vitamin D, provoked dehydration and the mechanism of the milk-alkali syndrome also contributed to this extremely high calcium level. It is concluded that hypoparathyroid patients being treated with vitamin D and calcium should be carefully monitored in the case of an intercurrent illness or a change in medication.

Topics: Calcium; Dihydrotachysterol; Female; Heart Valve Prosthesis Implantation; Humans; Hypercalcemia; Hypoparathyroidism; Middle Aged; Osteitis Deformans; Polypharmacy; Postoperative Complications; Proteus Infections; Renal Dialysis; Thyroid Neoplasms; Thyroidectomy; Treatment Outcome; Urinary Tract Infections

Topics: Adenocarcinoma; Adenoma; Adult; Aged; Calcitonin; Calcium; Carcinoma, Papillary; Dihydrotachysterol; Female; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Male; Middle Aged; Parathyroid Glands; Phosphates; Thyroid Neoplasms; Thyroidectomy; Transplantation, Autologous