Analyse der Beschwerden von Patienten mit iatrogenem Hypoparathyreoidismus

Grätz, Victoria

dc.contributor.advisor	Siggelkow, Heide Prof. Dr.	de
dc.contributor.author	Grätz, Victoria	de
dc.date.accessioned	2013-03-28T10:12:21Z	de
dc.date.available	2013-06-27T22:50:05Z	de
dc.date.created	2013-03-28T10:12:21Z	de
dc.date.issued	2013-03-28	de
dc.identifier.uri	http://hdl.handle.net/11858/00-1735-0000-0015-8D97-7	de
dc.identifier.uri	http://dx.doi.org/10.53846/goediss-3768
dc.language.iso	deu	de
dc.rights.uri	http://creativecommons.org/licenses/by-nc-nd/3.0/
dc.subject.ddc	610	de
dc.title	Analyse der Beschwerden von Patienten mit iatrogenem Hypoparathyreoidismus	de
dc.type	doctoralThesis	de
dc.title.translated	General symptoms in iatrogenic hypoparathyroidism	de
dc.contributor.referee	König, Sarah PD Dr.	de
dc.date.examination	2013-04-03	de
dc.description.abstracteng	Introduction 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.coReferee	Zerr, Inga Prof. Dr.	de
dc.contributor.thirdReferee	Oppermann, Martin Prof. Dr.	de
dc.subject.ger	Hypoparathyreoidismus	de
dc.subject.ger	Parathormon	de
dc.subject.ger	Calcium	de
dc.subject.ger	gastrointestinale Beschwerden	de
dc.subject.eng	hypoparathyroidism	de
dc.subject.eng	Parathyroid hormone	de
dc.subject.eng	calcium homeostasis	de
dc.subject.eng	gastrointestinal symptoms	de
dc.identifier.urn	urn:nbn:de:gbv:7-11858/00-1735-0000-0015-8D97-7-6	de
dc.affiliation.institute	Medizinische Fakultät	de
dc.subject.gokfull	Medizin (PPN619874732)	de
dc.description.embargoed	2013-06-27	de
dc.identifier.ppn	756705363

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Human- und Zahnmedizin [2877]

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