Overview.
Abnormal parathyroid function includes hyperparathyroidism and hypoparathyroidism. Hyperparathyroidism can be divided into two categories: primary, caused by parathyroid tumors; and secondary, caused by metabolic disorders and chronic hypocalcemia, which results in an overproduction of parathyroid hormone. Mental disorders are generally believed to be related to the significant elevation of blood calcium, in addition to renal failure and circulatory dysfunction also play a role. Hypoparathyroidism occurs mostly after thyroid surgery that mistakenly damages the parathyroid glands, and to a lesser extent after parathyroidectomy; in addition, there is also so-called idiopathic hypoparathyroidism of unknown cause.
Etiology
The main factor of psychiatric disorders associated with abnormal parathyroid function is closely related to blood calcium. It is generally believed that a significant increase in blood calcium is the main factor of psychiatric disorders associated with hyperparathyroidism, while a decrease in blood calcium leads to “tetanic psychosis”.
Symptoms
1. Psychiatric disorders associated with hyperparathyroidism
(1) mental disorders Common mental disorders are as follows: ① neurasthenia syndrome, mostly symptoms of autonomic dysfunction, indifference, loss of initiative, memory loss, inattention, calcium is generally more than 12mg/dl; ② depression, anxiety, emotional depression, accompanied by inattention, anxiety, anxiety, and so on; ③ mental retardation Mostly found in children’s cases, usually mild, but also can be Delirium – amnesia syndrome, ④ impaired consciousness, mostly delirium or confusion, mostly in acute onset, in parathyroid crisis can develop into coma, calcium is generally 16 to 19 mg / dl or 19 mg / dl or more, calcium and mental disorders prognosis is related to, the higher the calcium, the more serious mental disorders.
(2) Neurological and physical symptoms: thirst, nausea, loss of appetite, constipation, excessive sweating, vertigo, muscle relaxation, hypotonia, generalized weakness, myasthenia gravis, and spasticity, etc. Chorea-like involuntary movements are unique to children.
2. Hypoparathyroidism with mental disorders
(1) Mental disorders The mental symptoms of this disease are quite common, with a prevalence rate of 30% to 60%, including: (1) affective disorders: emotional instability, volatility, easy to cry, irritable, easy to anger, hysterical-like episodes, etc.; (2) manic or depressive state: mostly depression, anxiety, some manifested as mild mania; (3) hallucinations or delusional state: hearing hallucinations are common, and there are schizophrenic symptoms such as victimization and delusions of relationship; (4) mental disorders: severe cases may have severe memory loss, and some cases may have severe memory impairment; and (5) mental retardation. Severe cases may have serious memory loss, personality decline, etc.; ⑤ Disorders of consciousness, such as cloudy consciousness, acute confusion state, or wood stiffness, etc. The above mental symptoms usually occur about 3 to 4 months after tetany, and may last for several months, and the mental symptoms will gradually disappear 3 to 4 weeks after the blood calcium returns to normal.
(2) Neurological symptoms Hand-foot tetany is the most common, epileptic-like spasmodic seizures, extrapyramidal symptoms (tremor paralysis, chorea-like or torsades de pointes, etc.), cerebellar ataxia, cervical strabismus, myoclonic contracture, optic disc edema, and increased cranial pressure, etc. The abnormality rate of basal ganglia calcification is as high as 100% in patients with primary hypoparathyroidism.
Examination
Laboratory findings consistent with primary disease, such as hyper- or hypoparathyroidism.
ECT nuclide imaging is a specific and important imaging method, which introduces tracer amounts of radionuclides into the body (usually 99mTc or 131I), which are specifically taken up by the thyroid tissue and imaged, with the advantages of being fast, specific, accurate, and safe.
Ultrasound can clearly show the anatomical shape and size of the thyroid gland in the neck, the echogenicity of the internal tissues, and the presence of nodules and masses.
Diagnosis
1. Clearly diagnosed hypoparathyroidism or hyperparathyroidism, with symptoms, signs and laboratory tests based on abnormal parathyroid function.
2. The mental symptoms mentioned above accompanying hypoparathyroidism or hyperparathyroidism, especially when hypocalcemia is corrected, mental symptoms are relieved or disappear, which is conducive to the diagnosis.
3. It should be differentiated from other mental disorders associated with endocrine hypoparathyroidism and other functional psychiatric disorders such as schizophrenia, dysthymia and depression.
Treatment
Regardless of the type of parathyroid function abnormality, the first step in the treatment should be to actively prevent the triggering factors of mental disorder, such as respiratory tract infection, gastrointestinal diseases, bleeding, shock, surgery, trauma and psychological factors.
1. Hyperparathyroidism is mainly treated by surgery, and peritoneal dialysis can also be used to lower blood calcium. Mental disorders can be improved rapidly after the blood calcium is lowered, and anti-anxiety drugs can be used as symptomatic treatment. Patients with hypercalcemia can be treated with bisphosphonates (pamidronate and zoledronate), which can rapidly and effectively reduce blood calcium levels.
2. For the treatment of acute tetany, calcium salts can be given intravenously for the most rapid effect during the attack period, while oral calcium can be taken in chronic cases, and active VD preparations can be supplemented at the same time. During the medication period, blood calcium concentration must be measured frequently to prevent the blood calcium from being too high, and most of the patients can return to normal after proper treatment.
Prognosis
Hyperparathyroidism with mental disorder, blood calcium and its prognosis are related, the higher the blood calcium, the more serious mental disorder, mental disorder can basically improve rapidly after the blood calcium is lowered, hypoparathyroidism with mental disorder, most of the patients can return to normal after appropriate treatment, but those who have already had hypokinesia are difficult to recover even after appropriate treatment.