格雷夫斯病与原发性甲状旁腺功能亢进症并存。甲状腺功能亢进对血清钙和甲状旁腺激素的影响。

Concomitant Graves' disease and primary hyperparathyroidism. Influence of hyperthyroidism on serum calcium and parathyroid hormone.

作者信息

Arem R, Lim-Abrahan M A, Mallette L E

出版信息

Am J Med. 1986 Apr;80(4):693-8. doi: 10.1016/0002-9343(86)90827-2.

Abstract

Two patients with coexistent Graves' disease and primary hyperparathyroidism were studied during medical treatment of their hyperthyroidism. Serum free calcium level was initially quite elevated (1.61 and 1.71 mM, normal 1.12 to 1.28 mM), but immunoreactive parathyroid hormone values were only slightly increased. The immunoreactive parathyroid hormone values of 153 and 173 nleq/ml (normal less than 150 nleq/ml) were far lower than expected in hyperparathyroid patients with a similar degree of hypercalcemia. As the patients became euthyroid during thionamide treatment, calcium values decreased to 1.39 and 1.61 mM, respectively, and parathyroid hormone increased to values clearly suggestive of hyperparathyroidism (454 and 229 nleq/ml, respectively). Parathyroidectomy and subtotal thyroidectomy cured both the hyperparathyroidism and the thyrotoxicosis in each case. These observations suggest that thyroid hormone had potentiated the osteoclastic effects of parathyroid hormone and that the resulting exacerbation of hypercalcemia had produced a relative suppression of hormone secretion by the abnormal parathyroid tissue.

摘要

对两名同时患有格雷夫斯病和原发性甲状旁腺功能亢进症的患者在进行甲状腺功能亢进症药物治疗期间进行了研究。血清游离钙水平最初显著升高（分别为1.61和1.71 mM，正常范围为1.12至1.28 mM），但免疫反应性甲状旁腺激素值仅略有升高。免疫反应性甲状旁腺激素值分别为153和173 nleq/ml（正常低于150 nleq/ml），远低于甲状旁腺功能亢进症且血钙升高程度相似的患者的预期值。在硫代酰胺治疗期间患者甲状腺功能恢复正常时，钙值分别降至1.39和1.61 mM，甲状旁腺激素升高至明显提示甲状旁腺功能亢进症的值（分别为454和229 nleq/ml）。甲状旁腺切除术和甲状腺次全切除术在每种情况下均治愈了甲状旁腺功能亢进症和甲状腺毒症。这些观察结果表明，甲状腺激素增强了甲状旁腺激素的破骨细胞作用，并且由此导致的高钙血症加重对异常甲状旁腺组织的激素分泌产生了相对抑制作用。