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DOI: 10.1055/s-2002-33074
© Johann Ambrosius Barth
Pseudohypoparathyroidism and Graves'disease: a rare combination of two endocrinological diseases
Publication History
received 22 March 2001
first decision 22 June 2001
accepted 15 January 2002
Publication Date:
30 July 2002 (online)
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Summary
We report a 26-year-old woman presented at the day of admission in the I.C.U. with increased perspiration, plethora and distinct tetany of both legs. Particularly unusual was an exophthalmus on both sides, a rectal temperature of 38.3 ° Celsius and a blood pressure of high level (180/110 mmHg).
Laboratory findings were a low serum calcium concentration of 2.86 mval/l, a hyperphosphataemia (5.0 mg/dl), free thyroxine of 31.7 pmol/l, TSH basal of < 0.01 U/ml and positive MAK and TRAK.
Serum parathormone concentration was excessively high: 766 ng/l (12-72).
Ultrasound of the thyroid gland revealed a normal size with a volume of 10.4 ml; the echosonic state was not typical for Graves' disease.
The initial treatment consisted of high dose thiamazole and hydrocortisone intravenous, calciumcarbonate and propranolol per os.
After acute situation the treatment continued with thyreostatics, calcitriol and calciumcarbonate.
The symptoms at the day of admission (tetany) disappeared within 2 days; only local paraesthesia of fingers persisted longer.
Normalization of thyroid parameters was reached after 11 days; the serum calcium concentration persisted on an increasing but still lower level than standard (3.8 mval/l).
During substitution parathormone decreased to 443 ng/l.
What is unusual about this case is the combined appearance of autoimmunethyreoiditis (Graves' disease) and pseudohypoparathyroidism.
Key words:
Pseudohypoparathyroidism - Graves' disease
References
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Dr. med. A. Gerhardt
Department of medicine (Prof. Dr. med. K. Hackenberg)
Evangelisches Krankenhaus Herne
Academic teaching hospital of the University of Bochum
Wiescherstr. 24
44623 Herne, Germany
Phone: 02323/498-0
Fax: 02323/498-2485
Email: a.gerhardt@evk-herne.de