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Related Concept Videos

Hyperthyroidism II: Pathophysiology01:27

Hyperthyroidism II: Pathophysiology

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Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH...
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Hyperthyroidism I: Introduction01:25

Hyperthyroidism I: Introduction

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Hyperthyroidism is a type of thyrotoxicosis characterized by the thyroid gland's overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). This hormone excess increases the basal metabolic rate and enhances sensitivity to catecholamines.DiagnosisDiagnosis is based on clinical features and biochemical testing. It typically shows suppressed thyroid-stimulating hormone (TSH) levels below 0.4 mIU/L, with elevated free T3 and/or T4. Additional tests, including thyroid...
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The Parathyroid Glands00:59

The Parathyroid Glands

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The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
Oxyphil cells, whose functions remain elusive, emerge during late puberty, adding a layer of complexity to the parathyroid gland's intricacies. In contrast, principal parathyroid cells undertake a vital role by...
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Graves Disease II: Pathophysiology01:24

Graves Disease II: Pathophysiology

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Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor,...
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Synthesis and Functions of Calcitonin00:51

Synthesis and Functions of Calcitonin

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Calcitonin, a vital polypeptide hormone, regulates calcium levels within body fluids. It is released by the parafollicular cells, also known as C cells, situated in the follicular epithelium of the thyroid gland. Calcitonin responds to fluctuations in blood calcium levels and the influence of gastrointestinal hormones like gastrin and cholecystokinin.
The exact mechanisms by which calcitonin operates in calcium homeostasis remain elusive, but its significance is evident in several vital...
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Hormones and Bone Tissue01:17

Hormones and Bone Tissue

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The endocrine system produces and secretes hormones, which interact with the skeletal system. These hormones control bone growth, maintain bone once it is formed, and remodel it.
Hormones That Influence Osteoblasts and/or Maintain the Matrix
Several hormones are necessary for controlling bone growth and maintaining the bone matrix. The pituitary gland secretes growth hormone (GH), which, as its name implies, controls bone growth. This happens in several ways: first, it triggers chondrocyte...
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Generation of Hypoparathyroid Rats via Carbon-Nanoparticle-Assisted Parathyroidectomy
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Primary hyperparathyroidism presenting as hypercalcemic crisis: Twenty-year experience.

Dependra Narayan Singh1, Sushil Kumar Gupta2, Niraj Kumari3

  • 1Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Indian Journal of Endocrinology and Metabolism
|January 17, 2015
PubMed
Summary

Hyperparathyroid-induced hypercalcemic crisis (HIHC) occurs in 21% of advanced primary hyperparathyroidism (PHPT) cases and is linked to pancreatitis and parathyroid carcinoma. Bisphosphonates aid in rapid calcium reduction, facilitating early parathyroidectomy for successful outcomes.

Keywords:
Bisphosphonatehypercalcemic crisisparathyroidectomyprimary hyperparathyroidism

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Two Techniques to Create Hypoparathyroid Mice: Parathyroidectomy Using GFP Glands and Diphtheria-Toxin-Mediated Parathyroid Ablation
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Establishment of a Simple and Effective Rat Model for Intraoperative Parathyroid Gland Imaging
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Area of Science:

  • Endocrinology
  • Surgical Oncology

Background:

  • Hyperparathyroid-induced hypercalcemic crisis (HIHC) represents a severe manifestation of primary hyperparathyroidism (PHPT).
  • Advanced PHPT cases often present with significant hypercalcemia, necessitating urgent management strategies.

Purpose of the Study:

  • To determine the incidence of HIHC in surgically treated PHPT patients.
  • To analyze the clinical presentation, and short- and long-term outcomes of HIHC patients.
  • To evaluate the efficacy of bisphosphonate therapy and parathyroidectomy in managing HIHC.

Main Methods:

  • Retrospective review of 177 advanced PHPT patients undergoing parathyroidectomy between 1989 and 2010.
  • Patients with serum calcium ≥14 mg/dl were classified into the HIHC group.
  • Statistical analysis using ANOVA to compare groups, with P < 0.05 considered significant.

Main Results:

  • HIHC incidence was 21% (37 patients), with a higher rate of pancreatitis (13.5%) and parathyroid carcinoma (10.8%) compared to non-crisis patients.
  • Bisphosphonate therapy in seven crisis patients led to faster serum calcium normalization (4.5 days vs. 14.6 days), enabling earlier surgery without increasing postoperative hypocalcemia risk.
  • Postoperative eucalcemia rates were similar between crisis and non-crisis groups.

Conclusions:

  • HIHC patients face increased risks of pancreatitis and parathyroid carcinoma.
  • Bisphosphonate therapy is effective in rapidly lowering serum calcium, facilitating timely parathyroidectomy.
  • Combined bisphosphonate use and focused parathyroidectomy ensure successful, sustained eucalcemia and favorable long-term survival.