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Analyse der Beschwerden von Patienten mit iatrogenem Hypoparathyreoidismus

dc.contributor.advisorSiggelkow, Heide Prof. Dr.de
dc.contributor.authorGrätz, Victoriade
dc.date.accessioned2013-03-28T10:12:21Zde
dc.date.available2013-06-27T22:50:05Zde
dc.date.created2013-03-28T10:12:21Zde
dc.date.issued2013-03-28de
dc.identifier.urihttp://hdl.handle.net/11858/00-1735-0000-0015-8D97-7de
dc.identifier.urihttp://dx.doi.org/10.53846/goediss-3768
dc.language.isodeude
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/
dc.subject.ddc610de
dc.titleAnalyse der Beschwerden von Patienten mit iatrogenem Hypoparathyreoidismusde
dc.typedoctoralThesisde
dc.title.translatedGeneral symptoms in iatrogenic hypoparathyroidismde
dc.contributor.refereeKönig, Sarah PD Dr.de
dc.date.examination2013-04-03de
dc.description.abstractengIntroduction Persistent postsurgical iatrogenic hypoparathyroidism is a significant problem after thyroid surgery for 0.5 to 4 % of patients. Despite adequate therapy with calcium and vitamin D well-being is not easily achieved in these patients. This might be due to the unphysiological substitution of parathyroid hormone (PTH) by active vitamin D with altered calcium and phosphate metabolism, or alternatively due to thyroid surgery. Our aim was to investigate well-being, mood and general symptoms in patients with iatrogenic hypoparathyroidism. Material and Methods In a retrospective study 58 patients with hypoparathyroidism (mean age 50±12.44, female/male= 50/6) were compared with 53 patients after thyroid surgery with intact parathyroid function (mean age 55.7±11.29, female/male= 47/6). The routine questionnaire from the first visit to the endocrine clinic was used for evaluation. Hence symptoms and diseases were reported, including gastrointestinal, cardiological, neurological and psychological disorders. In addition, serum and urinary calcium/phosphor as well as vitamin D, PTH and thyroid hormones were measured. Results were analyzed for influence of age, sex, body mass index and duration of disease by logistic regression. For statistical analysis Statistica 9.0 was used, groups were compared by t-test and kendall’s tau analysis for non parametric data. Results As expected in pts. with hypoparathyroidism PTH was significantly lower compared to those with thyroid surgery only (p<0.001). In addition, serum calcium was lower, 25-OH-vitamin D and serum phosphate levels were higher in this group (p<0.001, p<0.05, p<0.05 respectively). There was no difference in 24 h urine for calcium and phosphate, bone markers or serum TSH levels between groups. Thyroid medication was given to 81% of those with thyroid surgery only versus 88% to those with additional hypoparathyroidism. Calcium was also given to 7.5% to pts. without hypoparathyroidism. Patients with hypoparathyroidism revealed significantly more gastrointestinal symptoms than controls (p<0.001). Gastrointestinal symptoms are correlated with low serum calcium and supplementation of calcium and calcitriol. Surprisingly, pts. after thyroid surgery without hypoparathyroidism declared more psychopathological symptoms (p<0.001). Discussion By routine questionnaire during initial clinical presentation significantly more patients with hypoparathyroidism suffered from gastrointestinal symptoms. No increase in psychological symptoms or depression was detectable in this group. Possibly the questionnaire is not sensitive enough for detection of a differentiated mental status. The increase in cardiopulmonary disease in patients with thyroid operation is explained by the higher age of pts.. Increased psychopathological symptoms in pts. after thyroid surgery without hypoparathyroidism might be explained by decreased vitamin-D-levels. Supplementation of calcium should not exceed the daily dose of 1000 mg. Furthermore pts. with gastrointestinal symptoms should not be treated with calcitriol.de
dc.contributor.coRefereeZerr, Inga Prof. Dr.de
dc.contributor.thirdRefereeOppermann, Martin Prof. Dr.de
dc.subject.gerHypoparathyreoidismusde
dc.subject.gerParathormonde
dc.subject.gerCalciumde
dc.subject.gergastrointestinale Beschwerdende
dc.subject.enghypoparathyroidismde
dc.subject.engParathyroid hormonede
dc.subject.engcalcium homeostasisde
dc.subject.enggastrointestinal symptomsde
dc.identifier.urnurn:nbn:de:gbv:7-11858/00-1735-0000-0015-8D97-7-6de
dc.affiliation.instituteMedizinische Fakultätde
dc.subject.gokfullMedizin (PPN619874732)de
dc.description.embargoed2013-06-27de
dc.identifier.ppn756705363


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