Hypoparathyroidism associated with fibrocystic osteitis

　　The causes of the onset of pseudohypoparathyroidism accompanied by fibrous cystic osteitis

　　The bones may deform, making fractures more likely. Hypocalcemia can cause sinus tachycardia, arrhythmia, and may also cause atrioventricular block, and in rare cases, it can cause congestive heart failure. Low blood calcium can increase the excitability of the vagus nerve, leading to cardiac arrest. Clinically, once hypocalcemia is found in serum calcium levels, as well as the above-mentioned ECG findings, attention should be paid to the possibility of this disease.

　　Most cases have no specific AHO body type, and a few have this body type. Patients may experience tetany caused by hypocalcemia, and the bones may deform, making fractures more likely. The kidneys of the patients do not respond to PTH, leading to reduced phosphorus excretion and hyperphosphatemia.

　　1, Actively control the primary disease and have regular physical examinations. Hypocalcemia is prone to occur after thyroid or parathyroid surgery.

　　2, Increase sun exposure, proper nutrition, and prevent malnutrition hypocalcemia caused by weight loss, chronic diarrhea, and other factors.

　　3, Calcium supplementation is not a panacea. For postmenopausal women or osteoporosis patients who have been taking calcium and vitamin D preparations for a long time, they should drink plenty of water, regularly check blood calcium and urine calcium levels, and prevent hypercalcemia caused by calcium supplementation.

　　The patient has hypocalcemia, hyperphosphatemia, increased alkaline phosphatase, increased PTH, and exogenous PTH does not increase cAMP or phosphorus excretion in the kidneys.

　　X-ray examination of the skeleton shows fibrous cystic osteitis.

　　1, High calcium diet for hypocalcemia

　　1, Half a pound of milk contains 300 milligrams of calcium, as well as various amino acids, lactic acid, minerals, and vitamins, which promote the digestion and absorption of calcium. Moreover, the calcium in milk is more easily absorbed by the human body, so milk should be the main food for daily calcium supplementation. Other dairy products such as yogurt, cheese, and milk candy are also good sources of calcium.

　　2. Seaweed and shrimp skin Seaweed and shrimp skin are high-calcium marine products. Eating 25 grams a day can supplement 300 milligrams of calcium. Moreover, they can also reduce blood lipids and prevent atherosclerosis. Seaweed can be cooked with meat or eaten cold after boiling, both of which are good dishes. Shrimp skin contains a higher amount of calcium, with 25 grams containing 500 milligrams of calcium. Therefore, using shrimp skin to make soup or dumplings is a good choice for daily calcium supplementation.

　　3.豆制品 Soybeans are high-protein foods and also contain a high amount of calcium. 500 grams of soy milk contains 120 milligrams of calcium, and 150 grams of tofu contains up to 500 milligrams of calcium. Other soy products are also good for calcium supplementation. Friendly reminder: soy milk needs to be boiled 7 times repeatedly before it can be consumed. Tofu should not be eaten with certain vegetables, such as spinach. Spinach contains oxalic acid, which can combine with calcium to form calcium oxalate complexes, thus hindering the absorption of calcium by the human body. Therefore, tofu and other soy products should not be cooked with spinach. However, if cooked with meat, the taste will be delicious and nutrition-rich.

　　4. Animal bones More than 80% of animal bones are calcium, but it is not soluble in water and difficult to absorb. Therefore, it can be broken up before making into food, boiled with vinegar over a slow fire, and then the floating oil is removed. Add some vegetables to make a delicious and fresh soup.

　　5. Vegetables Many varieties of vegetables are rich in calcium. One hundred grams of Chinese cabbage contains 230 milligrams of calcium; one hundred grams of rapeseed, fennel, coriander, celery, and other vegetables contain about 150 milligrams of calcium per 100 grams.

　　Second, pay attention to the diet for calcium supplementation

　　1. Excessive taste can cause calcium loss. Everyone knows that eating too much salt is bad for the body, but few people know that consuming too much salt increases the excretion of urinary calcium, affecting the retention of calcium in the human body. Therefore, the diet for calcium supplementation should be light in taste.

　　2. Bone broth cannot be used as a calcium-rich diet. Bone broth cannot be used as a calcium-rich diet, but it contains a lot of collagen, phospholipids, trace elements, and other nutritional ingredients that are beneficial to the human body.

　　3. High-protein diet affects calcium absorption. Many people think that eating more fish and shrimp can help supplement calcium, but the calcium content in fish and shrimp meat is extremely low. Unless you can eat the fish bones, fish skeletons, and shrimp shells together, it will not achieve the effect of calcium supplementation.

　　4. Balance your diet when supplementing calcium. The most important thing is to balance your diet and diversify your food intake.

　　Over-supplementation is also not good. The Chinese Nutrition Society recommends supplementing with 800 milligrams of calcium per day, with no more than 2000 milligrams. Eating too much calcium-rich food does not achieve the effect of calcium supplementation and may cause symptoms such as body edema, anorexia, nausea, and more.

　　Patients with pseudo-hypoparathyroidism accompanied by fibrous cystic osteitis with symptoms and signs should be treated, and the degree and speed of decrease in blood calcium determine the correction of pseudo-hypoparathyroidism accompanied by fibrous cystic osteitis. If the total calcium concentration is less than 7.5mg/dl (1.875mmol/L), treatment should be administered regardless of the presence or absence of symptoms.

　　1. If the symptoms of pseudothyroidism associated with fibrocystic osteitis are significant, such as with cramps, convulsions, hypotension, Chvostek sign or Trousseau sign positive, electrocardiogram showing Q-T interval ST segment prolongation with or without arrhythmia, etc., immediate treatment should be given, usually 10% calcium gluconate 10ml (containing Ca2+ 90mg) diluted and intravenously injected (more than 10min), which takes effect immediately after injection, and can be repeated if necessary to control symptoms. Heart rate should be closely monitored during injection, especially in patients using digitalis, to prevent the occurrence of serious arrhythmias. If pseudothyroidism associated with fibrocystic osteitis recurs, 10-15mg/kg of Ca2+ can be infused intravenously within 6-8 hours. Calcium chloride can also be used, but it has a strong irritant effect on veins. The concentration of Ca2+ should not exceed 200mg/100ml to prevent extravasation and cause irritation to veins and soft tissues. If the patient has hypomagnesemia, it must be corrected at the same time.

　　2. Pseudothyroidism in patients with chronic fibrocystic osteitis should first treat the cause of pseudothyroidism associated with fibrocystic osteitis, such as hypomagnesemia, vitamin D deficiency, malnutrition, etc.; in addition, oral calcium and vitamin D preparations (nutritional vitamin D or active vitamin D) can be given. Oral calcium preparations include calcium gluconate, calcium citrate, and calcium carbonate, which should be selected for application according to the condition of pseudothyroidism associated with fibrocystic osteitis, generally 1-2g per day, cod liver oil is rich in vitamin D, which can promote calcium absorption from the intestines, is inexpensive, but the effect is slow, once the effect occurs, it can last for a long time, and the blood calcium level should be monitored regularly to adjust the dosage. Active vitamin D includes 25(OH)2D3 and 1,25(OH)2

　　3. D3 (Osteocalcin), with a rapid effect, especially the latter, which begins to take effect 1-3 days after use, and has a short duration of action, is relatively safe, and can be used at a dose of 0.25-1μg per day. Thiazide diuretics can also be used on the basis of a low-salt diet for pseudothyroidism in patients with chronic fibrocystic osteitis without renal failure to reduce the excretion of urinary calcium.

　　Blood calcium levels can generally be corrected to the normal low value, correcting to the normal high value can lead to hypercalciuria, which is prone to urinary tract stones.