Treatment of hypoparathyroidism

It is necessary to highlight its features during an acute attack of tetany and emphasize the need for maintenance systematic therapy in the interictal period. For the treatment of hypoparathyroid crisis, a 10% solution of calcium chloride or calcium gluconate is administered intravenously. The dose is determined by the severity of the attack and ranges from 10 to 50 ml (usually 10-20 ml). The effect should occur at the end of the infusion. Due to the possibility of intoxication (risk of collapse, ventricular fibrillation), the drug should be administered slowly. Since calcium is excreted from the body within 6-8 hours, it is advisable to repeat the injections 2-3 times a day. In the interictal period, its preparations (gluconate, lactate, chloride) are used orally at a dose of 1-2 g / day after meals.

In a crisis, parathyroidin is also used - an extract of the parathyroid glands of cattle in a dose of 40-100 U (2-5 ml) intramuscularly. The effect occurs after 2-3 hours and lasts for 24 hours with a maximum effect after 18 hours. Parathyroidin is used for maintenance therapy in a limited way due to the possibility of developing resistance and allergies. If necessary, courses of treatment are carried out for 1.5-2 months with breaks of 3-6 months.

Of great importance in treatment are vitamin D preparations, which enhance intestinal absorption and reabsorption of calcium in the renal tubules, stimulate its mobilization from bones. The most effective vitamin D ₃ preparations are: IOHD3 - IOН cholecalciferol, oxydevite, alphacalcidiol, which are produced in an oil solution in doses of 1, 0.5 and 0.25 mcg in capsules for oral use, and 1,25(OH) ₂ D ₃ - 1,25(OH) ₂ cholecalciferol, rocaltrol, produced in the same doses and form and as an oil solution containing 2 mcg / ml (0.1 mcg in 1 drop). In the acute period, the daily dose can be 2-4 mcg in 2 doses, the maintenance dose is 0.5-1 mcg / day.

Treatment with vitamin D2 (ergocalciferol) in alcohol (200 thousand U/ml) and oil (200, 50, 25 thousand U/ml) solutions retains a certain value _. In the acute period, 200-400 thousand U/ml are prescribed, the maintenance dose is 25-50 thousand U/ml.

Treatment with 0.1% oil solution of dihydrotachysterol (tachystin, AT-10 in capsules) is widely used; 1 ml of this solution contains 1 mg of dihydrotachysterol. In the acute period, 1-2 mg is prescribed every 6 hours, the maintenance dose is 0.5-2 ml per day (selected individually).

Treatment is carried out under the control of a study of the calcium level in the blood to avoid overdose and the development of hypercalcemia, which is accompanied by polyuria, dry mouth, thirst, weakness, headache, nausea, abdominal pain, constipation. If hypercalcemia is detected, it is necessary to stop taking calcium preparations and reduce the dose or stop taking drugs that increase its content in the blood, and also to conduct treatment as in a hypercalcemic crisis.

Hypoparathyroidism is treated with a diet rich in calcium and magnesium salts (milk, dairy products, vegetables, fruits), with a restriction of phosphorus (meat). Refusal of meat products is especially necessary during the period of tetany. It is advisable to introduce ergocalciferol with food, which is contained in fish oil, herring, liver, egg yolk. To relieve hypomagnesemia in hypoparathyroidism, magnesium sulfate in a 25% solution is prescribed at 10-20 ml intramuscularly, in alkalosis - ammonium chloride up to 3-7 g / day. Sedatives and anticonvulsants (chloral hydrate in an enema, luminal, bromides) are used for symptomatic therapy. Intubation or tracheotomy is used in the presence of laryngospasm.

To create a calcium "depot" in the body, preserved bone is implanted into the muscle. Attempts have been made to implant parathyroid glands, although the effectiveness of these methods is questionable.

In pseudohypoparathyroidism, parathyroidin treatment is ineffective due to the insensitivity of the "target" tissues to it. Hypocalcemia in such patients must be compensated by administering calcium and vitamin D preparations. Encouraging results are obtained by using active vitamin D3 preparations _. However, hypercalcemia may occur with overdose or individual hypersensitivity. Due to the rarity of pseudohypoparathyroidism and the limited experience of vitamin D3 treatment, the question of its effect on metastatic calcification of soft tissues is still unclear.

Clinical examination

Patients with hypoparathyroidism should be under regular dispensary observation of an endocrinologist. With established stable therapy, monitoring of calcium and phosphorus levels in the blood is necessary once every 4-6 months. When initially prescribing therapy, changing medications or selecting doses - monitoring of calcium and phosphorus once every 7-10 days. Regular ophthalmological observation (cataract); X-ray examination of the state of the skull (calcification of the basal ganglia) and other bones according to clinical indications are necessary.

Working capacity depends on the severity of the process and the degree of drug compensation. In the latent form of hypoparathyroidism and the absence of obvious tetanoid attacks, it is partially preserved (with certain restrictions). Work not associated with significant mechanical, thermal and electrical effects on the neuromuscular apparatus is recommended; work near moving mechanisms and in transport is contraindicated. It is necessary to exclude physical and neuropsychic overstrain. Patients with frequent tetanoid attacks, as well as with persistent pathology of the central nervous system and with visual impairment due to cataracts are incapacitated.

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