Treatment of hypoparathyroidism
Last reviewed: 23.04.2024
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It is necessary to distinguish its features in the period of acute tetanus attack and emphasize the need for supporting systematic therapy in the interictal period. To treat the hypoparathyroid crisis intravenously, 10% calcium chloride or calcium gluconate solution is administered. 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. In connection with the possibility of intoxication (danger of collapse, ventricular fibrillation of the heart), the drug should be administered slowly. Since calcium is excreted from the body for 6-8 hours, it is advisable to repeat the injection 2-3 times a day. During the interictal period, his drugs (gluconate, lactate, chloride) are administered orally in a dose of 1-2 g / day after meals.
In case of crisis, also parathyroidine is used - an extract of parathyroid glands of cattle at a dose of 40-100 ED (2-5 ml) intramuscularly. The effect occurs after 2-3 hours and lasts a day with a maximum of action after 18 hours. Parathyroidin for maintenance therapy is used limitedly because of the possibility of developing resistance and the occurrence of allergies. If necessary, conduct treatment courses for 1.5-2 months with interruptions for 3-6 months.
Important in the treatment are the preparations of vitamin D, which strengthen intestinal absorption and reabsorption of calcium in the renal tubules, stimulate its mobilization from the bones. The most effective drugs are vitamin D 3 : IOHD3 - IOH, cholecalciferol, oxydevit, alfacalcidiol, which are released in oily solution in doses of 1, 0.5 and 0.25 μg in capsules for oral administration, and l, 25 (OH) 2 D 3 - 1,25 (OH) 2 cholecalciferol, rocataltrol, released in the same doses and form and in the form of an oil solution containing 2 μg / ml (0.1 mg in 1 drop). In the acute period, the daily dose can be 2-4 μg per 2 doses, maintaining 0.5-1 mcg / day.
The treatment with vitamin D 2 (ergocalciferol), alcohol (200 thousand units / ml) and oil (200, 50, 25 thousand units / ml) retains certain value . In an acute period, 200-400 thousand units / ml are prescribed, maintaining a dose of 25-50 thousand units / ml.
Widely used treatment with 0.1% oily solution of dihydrotachysterol (tachystin, AT-10 capsules), 1 ml of which contains 1 mg of dihydrotachysterol. In an acute period appoint 1 -2 mg every 6 hours, maintaining a dose of 0.5-2 ml per day (selected individually).
Treatment is carried out under the control of a study of the level of calcium 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 cancel the intake of calcium preparations and reduce the dose or cancel the drugs that increase its content in the blood, and also to treat as with hypercalcemic crisis.
To treat hypoparathyroidism, a diet rich in calcium and magnesium salts (milk, dairy products, vegetables, fruits) is applied, with phosphorus (meat) restriction. Refusal of meat products is necessary especially during the tetany period. It is advisable to administer ergocalciferol with food, which is contained in fish oil, herring, liver, egg yolk. To relieve hypomagnesemia in hypoparathyroidism, magnesium sulfate is prescribed in 25% solution in 10-20 ml intramuscularly, with alkalosis - ammonium chloride up to 3-7 g / day. Used for the purpose of symptomatic therapy, sedative and anticonvulsants (chloral hydrate in enema, luminal, bromides). If laryngospasm is present, intubation or tracheotomy is used.
To create a "depot" of calcium in the body make a plug in the muscle of the canned bone. Attempts were made to replant the parathyroid glands, although the effectiveness of these methods is questionable.
In pseudohypoparathyroidism, treatment with parathyroidin is ineffective due to the insensitivity of the tissues of the "targets" to it. Hypocalcemia in these patients is compensated for by the administration of calcium and vitamin D. The encouraging results are the use of active preparations of vitamin D 3. This may cause hypercalcemia in overdose or individual hypersensitivity. In connection with the rarity of pseudohypoparathyroidism and a small 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 supervision of the endocrinologist. With stable stable therapy, the level of calcium and phosphorus in the blood is monitored once every 4-6 months. At primary appointment of therapy, change of medicinal preparations or selection of doses - the control of calcium and phosphorus 1 time in 7-10 days. Regular ophthalmologic observation (cataract) is necessary; X-ray examination of the skull (basal ganglia calcification) and other bones according to clinical indications.
The ability to work depends on the severity of the process and the degree of medical compensation. With the latent form of hypoparathyroidism and the absence of obvious tetanoid seizures, it is partially preserved (with certain limitations). It is recommended to work that is not associated with significant mechanical, thermal and electrical effects on the neuromuscular apparatus, contraindicated labor in moving machinery, in transport. It is necessary to exclude physical and neuropsychic overstrain. Disabled patients with frequent tetanoid seizures, as well as with persistent pathology from the central nervous system and with visual impairments due to cataracts, are disabled.
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