Humans ; Hypocalcemia ; diagnosis ; prevention & control ; Monitoring, Intraoperative ; Parathyroid Hormone ; analysis ; Thyroidectomy

PURPOSE: Routine supplementation of high-dose calcium significantly decreased the risk of postoperative symptomatic hypocalcemia after thyroidectomy. However, there is an ongoing debate about whether the same results can be achieved with low-dose calcium supplementation. METHODS: Patients (n = 138) who underwent total thyroidectomy for thyroid cancer were 1:1 randomly assigned to receive oral supplements of 1,500 mg/day elemental calcium and 1,000 IU/day cholecalciferol for 2 weeks or no supplementation. Primary objective was to compare the incidence of symptomatic hypocalcemia for 3 days after total thyroidectomy. Secondary objective was to find the predictors for postoperative hypocalcemia in patients with thyroid cancer. RESULTS: Sixty-five patients in the calcium group and 69 patients in the control group were finally analyzed. The incidence of symptomatic hypocalcemia showed no difference between the calcium and control group (32.3% vs. 21.7%, P = 0.168). The total dosage of intravenous calcium (593.4 ± 267.1 mg vs. 731.6 ± 622.7 mg, P = 0.430) administered to patients with symptomatic hypocalcemia was also comparable between groups. In a multivariate analysis, parathyroid hormone level of 13 pg/mL at postoperative day 1 was only predictive for symptomatic hypocalcemia, and its incidence was 20.9 times (95% confidence interval, 6.8–64.5) higher in patients with parathyroid hormone <13 pg/mL. Other factors did not predict the development of hypocalcemia, including clinicopathological features and routine supplementation of low-dose calcium. CONCLUSION: Routine low-dose calcium supplementation did not reduce the risk of postoperative hypocalcemia. Patients who may benefit from calcium supplementation should be carefully selected.
Calcium ; Cholecalciferol ; Humans ; Hypocalcemia ; Hypoparathyroidism ; Incidence ; Multivariate Analysis ; Parathyroid Hormone ; Prospective Studies ; Thyroid Neoplasms ; Thyroidectomy

OBJECTIVETo explore the correlation among some biochemical indexes in the fluoride workers.

METHODSThe activities of superoxide dismutase(SOD), glutathione peroxidase (GSH-Px), catalase (CAT), alkaline phosphatase (AKP) and the level of calcitonin (CT), parathyroid hormone (PTH), IgG, IgA, IgM, Cu2+, Zn2+, Ca2+, Mg2+ and Se2+, F- in serum and in urine were measured in fifty male fluoride workers and fifty controls.

RESULTSThe levels of F-, CT, PTH, AKP and GSH-Px in serum and F- in urine in exposed group were significantly different from that in control group. Correlation analysis indicated that F- in urine and CAT(r = 0.3133, P < 0.05), CT and PTH(r = 0.5173, P < 0.01), Se2+ and CAT(r = 0.4354, P < 0.05) were positively correlated. There were significantly negative correlation between F- in serum and GSH-Px (r = -0.5202, P < 0.01) and positive correlation among Cu2+, Zn2+, Ca2+ and Mg2+ in serum.

CONCLUSION(1) Excess of fluoride may affect secretion of calcium adjusting hormone (CT, PTH); (2) Changes of AKP and GSH-Px may be regarded as health monitoring indexes; (3) The correlation of biochemical indexes plays an important role in studying the mechanism and the early prevention and treatment of industrial fluorosis.

Alkaline Phosphatase ; analysis ; Calcitonin ; analysis ; Catalase ; analysis ; Environmental Monitoring ; Fluorides ; toxicity ; Glutathione Peroxidase ; analysis ; Humans ; Male ; Occupational Exposure ; Parathyroid Hormone ; analysis ; Superoxide Dismutase ; analysis

PURPOSE: Postoperative hypocalcemia is a common complication of thyroidectomy. This study evaluated the incidence and predisposing risk factors for postoperative permanent hypocalcemia after total thyroidectomy. METHODS: There were 1,247 consecutive patients undergoing total thyroidectomy and complete treatment and observation for differentiated thyroid cancer between January 2012 to December 2012 who were enrolled in this study. Patients were divided into two groups, those remaining normalcalcemic (Group I-824 pts) and those who had hypocalcemia requiring treatment (Groups II-423 pts). Group II was subdivided into a transient hypocalcemic group (Group IIA-409 pts) and a permanent hypocalcemic group (Group IIB-14 pts). RESULTS: Female gender, thyroiditis, preserved parathyroid number, lateral lymph node metastasis, RAI treatment, preoperative parathyroid hormone and preoperative vitamin D were significantly associated with the development of postoperative hypocalcemia by multivariate analysis. Comparing patients with transient versus permanent hypocalcemia, tumor size and multiplicity were significantly related to the development of permanent hypocalcemia by multivariate analysis. RAI treatment and parathyroid hormone level on the postoperative third day were significantly related to recovery from transient hypocalcemia to normo-calcemia. CONCLUSION: Risk factors of postoperative hypocalcemia were associated with preoperative patient factors and advanced thyroid cancer. Advanced thyroid cancer was a risk factor for permanent hypocalcemia. To prevent postoperative hypocalcemia, we should focus on patient condition and need to preserve parathyroid gland more carefully in thyroid surgery.
Female ; Humans ; Hypocalcemia* ; Incidence ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Parathyroid Glands ; Parathyroid Hormone ; Risk Factors* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy* ; Thyroiditis ; Vitamin D

OBJECTIVETo observe the effects of different human parathyroid hormone 1-34 (hPTH1-34) administration on SaoS-2 cells, and explore the mechanism of bone formation improvement.

METHODSEach cycle covered 48 h. SaoS-2 cells were continuously or intermittently stimulated by 50 ng/ml hPTH1-34 for 1, 3, 6, 12, and 24 h in each cycle. Total RNA was extracted by Trizol kit. Alkaline phosphatase (ALP), osteocalcin or bone Gla-containing protein (BGP) and cyclic adenosine monophosphate (cAMP) levels were measured by chemical method, radioimmunoassay and competitive protein binding method, respectively. c-fos gene expression was semi-quantified by reverse transcription polymerase chain reaction (RT-PCR).

RESULTSALP level was time-dependently increased in 1, 3 and 6 h stimulation, especially in 3 and 6 h (compared with control, P < 0.01; P < 0.05 or P < 0.01 compared with continuous stimulation). The cAMP level was time-dependently increased in 3 and 6 h incubation (P < 0.05 compared with control and continuous stimulation). Intermittent hPTH1-34 stimulation had more effects on cAMP level than continous action (P < 0.001). hPTH1-34 intermittent stimulation of 1, 3, and 6 h enhanced c-fos gene expression time-dependently.

CONCLUSIONSIntermittent hPTH1-34 stimulation has a stronger effect on osteoblast than continuous action, especially in 3, 6 h in each cycle intermittent stimulation. The synchronous responses of c-fos, ALP and cAMP to hPTH1-34 suggest that hPTH1-34 affect Saos-2 cells through cAMP dependent protein kinase A (PKA) pathway and c-fos gene paly an important role.

Alkaline Phosphatase ; analysis ; Cells, Cultured ; Humans ; Osteoblasts ; cytology ; Osteocalcin ; analysis ; Osteogenesis ; drug effects ; Osteosarcoma ; genetics ; pathology ; Parathyroid Hormone ; pharmacology ; Parathyroid Hormone-Related Protein ; pharmacology ; Peptide Fragments ; pharmacology ; Proto-Oncogene Proteins c-fos ; biosynthesis ; genetics ; RNA, Messenger ; biosynthesis ; genetics

OBJECTIVETo establish HEK293 cell lines with stable expression of human parathyroid hormone (PTH) receptors.

METHODSThe purified gene fragments of PTH-related peptide receptor (PTHR) and its mutant form (DSEL) were cloned separately into pcDNA3.1(+) vector after digestion with EcoR I and Not I, and the resulted pcDNA3.1(+)-PTHR and pcDNA3.1(+)-DSEL plasmids were verified by restriction enzyme digestion and DNA sequencing. HEK293 cells were transfected with these plasmids and the expression of PTHR and DSEL in the cells were examined by RT-PCR and ELSIA.

RESULTSSequencing and restriction enzyme digestion analysis showed that PTHR and DSEL cDNAs were correctly cloned into pcDNA3.1(+)vector. After a 48-h transfection of HEK293 cells with the recombinant plasmids and G418 selection, the positive cell clones stably expressing the constructs were obtained, which showed expressions of PTHR and DSEL mRNAs detected by RT-PCR. These positive cells showed high levels of PLC and aAMP production in response to PTH stimulation.

CONCLUSIONThe HEK293 cell lines with stable expression of PTH1R or DSEL gene established in this study provide useful cell models for studying the physiological functions of PTH peptides.

Gene Expression ; Genetic Vectors ; HEK293 Cells ; Humans ; Plasmids ; Receptors, Parathyroid Hormone ; genetics ; metabolism ; Sequence Analysis, DNA ; Signal Transduction ; genetics ; Transfection

OBJECTIVEHypoparathyroidism is one of the most serious complications of thyroidectomy. It is important to identify the parathyroid glands during thyroidectomy. In order to find an economic, simple and less traumatic way to identify the parathyroid glands and testify its feasibility, fine-needle aspiration of suspected parathyroid tissue was used to measure the parathyroid hormone (PTH) levels during the surgical procedure.

METHODSFrom Nov. 2011 to Apr. 2012, 50 patients were recruited for thyroid surgery in the Sun Yat-sen University Cancer Centre. During surgery, fine-needle aspiration of suspected tissues, including parathyroid gland, thyroid gland, muscle, fat tissue, and lymph node, was performed, the PTH levels were measured. In addition, the tissues above-mentioned were taken to pathological examination. Statistical processing was adopted to determine the sensitivity and specificity of intraoperative fine-needle aspiration with measurement of PTH level in finding the pathology of the parathyroid gland.

RESULTSThere were 237 tissues from 50 patients in total, and 45 of them were certified as the parathyroid glands by pathology. Intra-operative PTH (ioPTH) of the tissues in forty-four cases were higher than 600 ng/L, ioPTH of the tissues in one case was lower than 600 ng/L, and it was 160 ng/L. The highest ioPTH in other cases was 537.7 ng/L. The sensitivity was 97.8%. The specificity was 100%. The difference between the sensitivity and the specificity of two groups was not statistically significant, and P > 0.05. The level of PTH of parathyroid gland were much higher than other tissues, and P < 0.001.

CONCLUSIONSThe level of ioPTH of parathyroid gland were far higher than thyroid, muscle, fat, lymph node. It is an economic, fast and less traumatic way to identify the parathyroid gland by using the fine-needle aspiration of the parathyroid tissue with measurement of PTH levels. The sensitivity and the specificity are high. It can be used in the thyroidectomy to identify the parathyroid glands.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy, Fine-Needle ; methods ; Child ; Female ; Humans ; Male ; Middle Aged ; Parathyroid Glands ; chemistry ; pathology ; surgery ; Parathyroid Hormone ; analysis ; Sensitivity and Specificity ; Thyroidectomy ; Young Adult

OBJECTIVE: To investigate the relationship of polymorphisms in osteoprotegerin (OPG)-receptor activator of NF-kB ligand (RANKL) gene to changes in circulating OPG and soluble RANKL (sRANKL) levels and in bone mineral density (BMD) after hormone therapy (HT) in postmenopausal Korean women. METHODS: The OPG T245G, and G1181C polymorphisms and RANKL rs2277438 A/G polymorphism were analyzed by polymerase chain reaction-restriction fragment length polymorphsim (PCR-RFLP) or direct DNA sequencing in 236 postmenopausal Korean women receiving sequential HT for 1 year. Serum OPG, sRANKL, bone alkaline phosphatase, CrossLaps (CTX), osteocalcin, clacitonin, parathyroid hormone, calicum, and phophorus were measured using enzyme-linked immunosorbent assay (ELISA), immunoassay and atomic absorptiometry respectively. BMD at the lumbar spine and proximal femur was determined by dual energy X-ray absorptiometry. RESULTS: The annual percent changes of BMD were not associated with single or combined genotypes of OPG and RANKL gene polymorphisms, and the distributions of these genotypes were not different between HT-responders and HT-nonresponders (women who lose more than 3% of bone mass per year). After HT of 6 months, change in serum sRANKL levels was significantly higher in GG genotype than in other genotype of RANKL gene polymorphism. No differences in the 6 month changes of other bone turnover markers including circulating OPG levels after HT were noted across single OPG genotype and combined genotypes of OPG and RANKL polymorphisms. CONCLUSIONS: The OPG T245G, and G1181C polymorphisms, and RANKL polymorphism did not associate with change in BMD after HT in postmenopausal Korean women, and RANKL polymorphism affects change in circulating sRANKL levels after HT.
Absorptiometry, Photon ; Alkaline Phosphatase ; Bone Density* ; Enzyme-Linked Immunosorbent Assay ; Female ; Femur ; Genotype ; Humans ; Immunoassay ; NF-kappa B* ; Osteocalcin ; Osteoprotegerin* ; Parathyroid Hormone ; Sequence Analysis, DNA ; Spine

OBJECTIVE: Serum parameters of calcium homeostasis were measured based on previously published evidence linking osteoporotic fractures and/or bone/mineral loss with antipsychotics. METHODS: Prospective, four-week, time-series trial was conducted and study population consisted of patients of both genders, aged 35-85 years, admitted within the routine practice, with acute psychotic symptoms, to whom an antipsychotic drug was either introduced or substituted. Serial measurements of serum calcium, phosphorous, magnesium, 25(OH)D, parathyroid hormone, calcitonin, osteocalcin and C-telopeptide were made from patient venous blood samples. RESULTS: Calcium serum concentrations significantly decreased from baseline to the fourth week (2.42+/-0.12 vs. 2.33+/-0.16 mmol/L, p=0.022, n=25). The mean of all calcemia changes from the baseline was -2.6+/-5.7% (-24.1 to 7.7) with more decreases than increases (78 vs. 49, p=0.010) and more patents having negative sum of calcemia changes from baseline (n=28) than positive ones (n=10) (p=0.004). There were simultaneous falls of calcium and magnesium from baseline (63/15 vs. 23/26, p<0.001; OR=4.75, 95% CI 2.14-10.51), phosphorous (45/33 vs. 9/40, p<0.001; 6.06, 2.59-14.20) and 25(OH)D concentrations (57/21 vs. 13/35, p<0.001; 7.31, 3.25-16.42), respectively. Calcemia positively correlated with magnesemia, phosphatemia and 25(OH)D values. Parathyroid hormone and C-telopeptide showed only subtle oscillations of their absolute concentrations or changes from baseline; calcitonin and osteocalcin did not change. Adjustment of final calcemia trend (depletion/accumulation) for relevant risk factors, generally, did not change the results. CONCLUSION: In patients with psychotic disorders and several risks for bone metabolism disturbances antipsychotic treatment was associated with the decrease of calcemia and changes in levels of the associated ions.
Antipsychotic Agents* ; Blood Chemical Analysis ; Bone and Bones ; Calcitonin ; Calcium* ; Homeostasis ; Humans ; Ions ; Magnesium ; Metabolism* ; Minerals ; Osteocalcin ; Osteoporotic Fractures ; Parathyroid Hormone ; Prospective Studies ; Psychotic Disorders ; Risk Factors

BACKGROUNDThe treatment of hypoparathyroidism (HPT) is still a difficult clinical problem, which necessitates a new therapy. Gene therapy of HPT has been valuable, but how to improve the gene transfer efficiency and expression stability is a problem. This study was designed to optimize the gene therapy of HPT with hematopoietic stem cells (HSCs) recombined with the parathyroid hormone (PTH) gene.

METHODSThe human PTH gene was amplified by polymerase chain reaction (PCR) from pcDNA3.1-PTH vectors and inserted into murine stem cell virus (MSCV) vectors with double enzyme digestion (EcoRI and XhoI). The recombinant vectors were transfected into PA317 packaging cell lines by the lipofectin method and screened by G418 selective medium. The condensed recombinant retroviruses were extracted and used to infect HSCs, which were injected into mice suffering from HPT. The change of symptoms and serum levels of PTH and calcium in each group of mice were investigated.

RESULTSThe human PTH gene was inserted into MSCV vectors successfully and the titres were up to 2 x 10(7) colony forming unit (CFU)/ml in condensed retroviral solution. The secretion of PTH reached 15 ng.10(-6).cell(-1) per 48 hours. The wild type viruses were not detected via PCR amplification, so they were safe for use. The mice suffering from HPT recovered quickly and the serum levels of calcium and PTH remained normal for about three months after the HSCs recombined with PTH were injected into them. The therapeutic effect of this method was better than simple recombinant retroviruses injection.

CONCLUSIONSThe recombinant retroviral vectors MSCV-PTH and the high-titre condensed retroviral solution recombined with the PTH gene are obtained. The recombinant retroviral solution could infect HSCs at a high rate of efficiency. The infected HSCs could cure HPT in mice. This method has provided theoretical evidence for the clinical gene therapy of HPT.

Animals ; Antigens, CD34 ; analysis ; Female ; Genetic Therapy ; Genetic Vectors ; genetics ; Hematopoietic Stem Cells ; Humans ; Hypoparathyroidism ; blood ; therapy ; Mice ; Parathyroid Hormone ; blood ; genetics ; Retroviridae ; genetics