Murakami T, Noguchi S, Murakami N, Kato R, Ohta Y
Noguchi Thyroid Clinic and Hospital Foundation, Beppu, Oita.
Nihon Naibunpi Gakkai Zasshi. 1989 Aug 20;65(8):771-80. doi: 10.1507/endocrine1927.65.8_771.
The levels of serum calcium (Ca), inorganic phosphate (P) and mid-molecular parathyroid hormone (PTH) were measured in 37 patients with Graves' disease (12 in hyperthyroid state, 25 in euthyroid state followed by subtotal thyroidectomy), 6 with papillary carcinoma of the thyroid, 8 with benign nodular goiter and 19 healthy control subjects in order to investigate the change in these levels before and after thyroidectomy. The levels of serum Ca and P of the hyperthyroid patients with Graves' disease were 9.73 +/- 0.30 mg/dl and 4.47 +/- 0.44 mg/dl, respectively, which were significantly higher than those of healthy control subjects. No significant difference in the levels of serum PTH was observed between hyperthyroid patients with Graves' disease and healthy control subjects. The levels of serum Ca, P and PTH of euthyroid patients with Graves' disease were not significantly different from those of healthy control subjects. In the patients with Graves' disease who had undergone subtotal thyroidectomy followed by postoperative tetany, serum Ca and serum PTH decreased significantly from 9.39 +/- 0.45 mg/dl to 7.90 +/- 0.33 mg/dl and from 406.6 +/- 164.4 pg/ml to 229.9 +/- 136.0 pg/ml, respectively, after surgery, but there was no change in serum P. In the patients without postoperative tetany, serum Ca and serum P decreased significantly after surgery from 9.65 +/- 0.36 mg/dl to 9.15 +/- 0.33 mg/dl and from 4.03 +/- 0.46 mg/dl to 3.47 +/- 0.54 mg/dl, respectively, without any change in the levels of serum PTH. In the patients with papillary carcinoma or benign nodular goiter without postoperative tetany, the levels of serum Ca, P and PTH did not change after surgery. In the patients with papillary carcinoma followed by postoperative tetany, serum Ca decreased significantly after surgery with concomitant decrease of serum PTH. It was concluded that excessive thyroid hormones influenced Ca metabolism, and the transient tetany following subtotal thyroidectomy for Graves' disease seemed to be due to both the absorption of Ca by hungry bone and parathyroid hypofunction.
为了研究甲状腺切除术前、后这些指标的变化，对37例格雷夫斯病患者（12例处于甲状腺功能亢进状态，25例处于甲状腺功能正常状态，随后接受甲状腺次全切除术）、6例甲状腺乳头状癌患者、8例良性结节性甲状腺肿患者以及19名健康对照者测定了血清钙（Ca）、无机磷（P）和中分子甲状旁腺激素（PTH）水平。格雷夫斯病甲状腺功能亢进患者的血清Ca和P水平分别为9.73±0.30mg/dl和4.47±0.44mg/dl，显著高于健康对照者。格雷夫斯病甲状腺功能亢进患者与健康对照者的血清PTH水平无显著差异。格雷夫斯病甲状腺功能正常患者的血清Ca、P和PTH水平与健康对照者无显著差异。在接受甲状腺次全切除术并术后发生手足搐搦症的格雷夫斯病患者中，术后血清Ca和血清PTH分别从9.39±0.45mg/dl显著降至7.90±0.33mg/dl，从406.6±164.4pg/ml降至229.9±136.0pg/ml，但血清P无变化。在未发生术后手足搐搦症的患者中，术后血清Ca和血清P分别从9.65±0.36mg/dl显著降至9.15±0.33mg/dl，从4.03±0.46mg/dl降至3.47±0.54mg/dl，血清PTH水平无任何变化。在未发生术后手足搐搦症的甲状腺乳头状癌或良性结节性甲状腺肿患者中，术后血清Ca、P和PTH水平未发生变化。在发生术后手足搐搦症的甲状腺乳头状癌患者中，术后血清Ca显著下降，同时血清PTH也下降。研究得出结论，过量的甲状腺激素影响钙代谢，格雷夫斯病患者甲状腺次全切除术后短暂的手足搐搦症似乎是由于饥饿骨对钙的吸收和甲状旁腺功能减退共同所致。
