Our topic still continues with hypoparathyroidism.
Botched thyroidectomy… apart from where
the patient initially might have started with
primary hyperparathyroidism and there might
have been inadvertent, excessive pyrothyroidectomy
resulting in hypoparathyroidism.
If the patient is required to have a thyroidectomy
because of its proximity to the parathyroids
may result in excess or collateral damage
to the parathyroids rendering your patient
Congenital deficiency... here, you should
be thinking about DiGeorge syndrome.
You have your chromosome 22, a long arm 11
deletion, therefore third and fourth pharyngeal
pouches are missing, no parathyroids are present.
In addition, the third pharyngeal pouch responsible
for developing the inferior parathyroids,
the patient, the child is hypocalcemic; in
addition, the thalamus does not form properly.
Therefore; look for a child that is suffering
from tetany, hypocalcemia; result in tetany,
In addition, there might be recurrent infection.
Usually, it will be the viral type; malformed
third and fourth pharyngeal pouches resulting
Abnormal facies, sometimes with your chromosome
22, you want to be familiar with the syndrome
congenitally that the boards love asking about
called velocardiofacial abnormalities.
The velocardiofacial abnormalities may result
in facies issue, congenital heart defects
and cognitive behavior and psychiatric problems,
Velocardiofacial issues with chromosome 22,
something that you want to know from a embryologic,
pathologic point of view.
Increased susceptibility to infection, why
Because the thalamus may not be present, inadequate
education of your T-cells, therefore rendering
the patient susceptible to infection, the
Idiopathic, autoimmune disease and then familial
hypoparathyroidism, chronic mucocutaneous
candidiasis is something that you want to
keep in mind when dealing with familial hypoparathyroidism.
Differentials of hypoparathyroidism, clinical
features include the following: whenever there
is decrease in parathyroid, there will obviously
be decrease in calcium and therefore, the
muscle, the skeletal muscle is extremely sensitive
to certain tapping.
Tapping of the facial nerve may result in
contraction of muscles of the eyes, nose and
mouth and we then refer to as being Chvostek
There might be circumoral numbness or paraesthesia
of distal extremity and perhaps carpopedal
spasms, especially when there is a, let’s
say, a brachial cuff that is placed around
Mental status changes, QT prolongation might
be seen with hypoparathyroidism and hypocalcemia;
serum calcium will be low here because there’s
decreased levels of PTH; decreased ability
to properly evacuate the phosphate from your
So, therefore, there will be increased phosphate
In addition, because of decreased PTH in circulation,
the osteoclasts will not function as well
as they should.
And so, therefore, there will be thickening
of the bone.
The thickening of the bone, pay attention
here, we’re now referring to osteoporosis,
this is osteosclerosis and that to you should
indicate or def-defines thickening of your