Do a good job in health management of residents returning home from discharge of shelter hospital in Shanghai
2022-04-12
There is such an organ in our neck. As a "demon", it can make people's body have all kinds of symptoms that are different from horses and cattle. Some patients have stones, some have bone pain or even fractures, some have gastrointestinal discomfort, abdominal distension and nausea... But no matter whether they were in urology, orthopedics or gastroenterology before, they finally "meet" in the thyroid specialist clinic. Who is this scourge? Let's invite a doctor to reveal. Symptoms are different from those of horses and cattle It's all the trouble We often encounter such situations in clinic: Uncle Liu often has kidney stones repeatedly, which is not good at all. It seems that there is an endless stream of kidney stones. The reason is unknown and the distress doubled; Aunt Wang is in her fifties. She is in her prime of life. She should be strong, but she has bone pain all over her body from time to time. She has broken bones many times for no reason. She even has difficulty walking, but she can't find the reason; Sister Li has digestive system symptoms such as abdominal distension, constipation, nausea and loss of appetite. The primary cause of these thyroid problems is that the patients with parathyroid diseases are found to have abnormal thyroid function before they come to the clinic. The parathyroid gland is usually small and pale yellow, just like soybeans. It "jumps up and down" on the back of the thyroid gland. The number is also unpredictable, ranging from 1 to 8, but most people have 4. Although the parathyroid gland is not as famous as the thyroid gland, its role as a younger brother next to the big brother of the thyroid gland can not be underestimated. Once they get sick, they may get out of control. Through "heresy" "Scourge" other organs Now let's learn how the parathyroid gland affects other organs of the body through "heresy". Parathyroid hormone (PTH) secreted by parathyroid gland, calcitonin (CT) secreted by thyroid gland and vitamin D jointly regulate the level of blood calcium and phosphorus. Its main function is to release bone calcium into the blood, and then excrete it from the kidney to regulate the blood calcium balance. Therefore, the main target organs of parathyroid hormone are bone and kidney. When the secretion of parathyroid hormone is insufficient, it can cause the decrease of blood calcium, convulsive symptoms of hands and feet, hypocalcemia, hyperphosphatemia and even death; However, when it is secreted too much, it will cause osteolysis, prone to fracture, and stones of different sizes may be formed in renal tubules, calices or ureters. Many patients are accidentally found to have parathyroid diseases because of kidney stones. Therefore, in the previous case, uncle Liu's kidney stone is a urinary system symptom caused by hyperparathyroidism. When hyperparathyroidism and excessive secretion of parathyroid hormone, bone calcium enters the blood and increases blood calcium. When it exceeds the absorption capacity of the kidney, a large amount of calcium will deposit in the kidney and cause kidney stones, which are manifested as increased urine volume, nocturia, thirst and so on. There can also be renal stones and renal parenchymal calcification, recurrent renal colic and hematuria. Renal calcinosis can lead to the gradual decline of renal function, and finally lead to renal insufficiency. Aunt Wang's multiple unexplained fractures are due to the damage to the bone caused by hyperparathyroidism. In the early stage, bone pain mainly occurred in the hips, waist and back, ribs and limbs, with local tenderness. The later stage showed fibrocystic osteoarthritis, bone deformity and pathological fracture, short stature and difficulty in walking; Some patients can also have bone cysts, manifested as local fracture uplift. Sister Li has digestive system disorders caused by hyperparathyroidism, including loss of appetite, abdominal distension, constipation, indigestion, nausea and vomiting. If calcium salt is deposited on the skin, it can also cause skin pruritus. Check these items You can find out the "real murderer" Parathyroid gland can occur in any age group, but it is common in adults. The peak of incidence is 30 to 50 years old, and postmenopausal women are more than men. It can be seen that parathyroid diseases have the tendency of "emphasizing women over men". What tests do we need to do for the parathyroid gland? We can go to the hospital for blood test. There is a value of blood calcium on the blood biochemical checklist. If we find that the blood calcium is high, we must make further examination. Most of the parathyroid hormone levels can be further confirmed; At the same time, check the level of vitamin D to rule out hyperparathyroidism caused by vitamin D deficiency; Another is imaging examination: observe whether the metabolism of parathyroid gland is vigorous through neck ultrasound, neck enhanced CT, 99mTcMIBI parathyroid imaging, etc. In addition, if the newborn suffers from tetany, don't forget to trace whether the mother has parathyroidism. The high blood calcium of the mother with parathyroidism is transmitted to the fetus through umbilical cord blood, so as to inhibit the growth and development of the fetal parathyroid gland. Therefore, when the fetus leaves the mother after delivery, there will be hypoparathyroidism and neonatal tetany. So for patients with hyperparathyroidism, if they belong to primary hyperparathyroidism, once the diagnosis is clear, surgical treatment is the only way to cure them; For secondary hyperparathyroidism, if the cause of secondary parathyroid function can be eliminated, most of the hyperparathyroidism can subside. Such patients should avoid high calcium diet in their daily diet, such as shrimp skin and bean products. Drinking more water will help prevent the occurrence of kidney stones. Patients with hypoparathyroidism need a high calcium and low phosphorus diet. It should be noted that foods with high calcium usually contain more phosphorus. For example, bean products and dairy products with high calcium also contain more phosphorus and cannot be eaten. In addition, foods containing more phosphorus include chocolate, nuts, animal offal, etc. These patients can eat some foods with low phosphorus content, mainly including melon dishes, towel gourd, white gourd, cucumber, balsam pear, as well as tomatoes, celery, spinach and rape. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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