POLIS Working Papers Dipartimento di Politiche Pubbliche e Scelte Collettive – POLIS Department of Public Policy and Public Choice – POLIS POLIS Working Papers n. 176 Costituzioni di microstati europei: I casi di Cipro, Liechtenstein e Città del Vaticano Fabio Longo and Jőrg Luther UNIVERSITA' DEL PIEMONTE ORIENTALE "Amedeo Avogadro" ALESSANDRIA
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Your GP or Endocrinologist may also check: What do I need to know about my medication?
Kidney function The aim of treatment is to abolish symptoms – not Phosphate and magnesium levels to restore ‘normal' calcium levels in the blood. Vitamin D levels In the absence of PTH, higher levels of calcium are found in the urine for a given blood calcium level. When hypoparathyroidism occurs as a complication This can cause kidney stones or calcium deposits in You have been diagnosed with
of surgery, the symptoms may start within hours to the kidneys (nephrocalcinosis), even when blood a few days after surgery. Diagnosis of a rare genetic calcium levels are in the ‘normal' range. Here is some information to help you manage
condition may take a little while. The target range is between 2.0-2.25mmol/L of your health.
adjusted calcium levels. The target range is How is hypoparathyroidism treated?
approximate and depends on patient symptoms. In the UK, you are likely to be prescribed: This is achieved with an appropriate dose of What is hypoparathyroidism?
Calcium: Mild disease can be treated with
alfacalcidol or calcitriol so that most of your Hypoparathyroidism (HPTH) is a rare disorder in calcium supplements alone. Each tablet of calcium can come from your diet and you will not which insufficient levels of parathyroid Calcichew®, Cacit® and Calcium-500® contains need to take too many calcium supplements. The hormone lead to low levels of calcium. 500mg; Adcal® contains 600mg; Sandocal-400® doses are typically split over the day. Parathyroid glands are four small glands and Sandocal-1000® contains 400mg and Calcium should be taken at meal times. which lie behind the butterfly-shaped thyroid 1000mg of elemental calcium respectively. High It can take several months to get the balance right. gland in your neck. These glands produce doses (>2000mg per day) should generally be Over time, your medication requirements can also parathyroid hormone (PTH), which closely change. This is often revealed by an increase or regulates calcium levels. Calcium is important Vitamin D: Most patients will not achieve
decrease in your calcium levels which you may feel for functioning of nerve, muscle, bone and other cell functions. adequate control with calcium alone. Active as recognisable symptoms. forms of vitamin D such as calcitriol or
You and your doctor need to learn to recognise alfacalcidol are favoured over high dose
your particular symptoms so that your medication What causes hypoparathyroidism?
colecalciferol or ergocalciferol. They are easier may be adjusted accordingly. The commonest cause is destruction of the to adjust in response to calcium levels. Symptoms can still be felt when the test results are parathyroid glands during neck surgery. The Maintenance dose of calcitriol or alfacalcidol is in the normal range (2.20 – 2.60 mmol/L) which is a glands may also be damaged by the immune typically between 0.5 – 2.0 micrograms daily. wide range. If your levels are unstable, keep a diary system. Some people are born with the Doses up to 3.0 micrograms are often required. of test results, doses and symptoms to help you condition (congenital). Sometimes, the cause is Calcitriol (Rocaltrol®) capsules come in 0.25 recognise your symptoms and understand what is unknown (idiopathic). microgram (red/white capsules) and 0.5 microgram (white capsules). Alfacalcidol (non- How is the condition diagnosed?
proprietary) capsules come in 0.25, 0.5 and 1.0 What should I do in a crisis?
The initial diagnosis is often done by your GP microgram strengths. A ‘crisis' can arise out of very low or very high who will assess symptoms and take a simple Magnesium may need to be corrected in post-
calcium (see below). blood test to measure calcium. If this is low, surgical HPTH if levels are found to be low. Seek help. You can contact your Endocrine you will be referred to an endocrinologist. Levothyroxine (thyroid hormone replacement) is
Specialist Nurse, Endocrinologist or your GP. needed if you had your thyroid gland removed. Your calcium may need to be increased or cut out Diagnosis is by means of blood tests showing: This should be taken apart from calcium Low parathyroid hormone (PTH) levels medication if possible (ideally 4h, at least 2h). You must never adjust your alfacalcidol or calcitriol
doses on your own. Low calcium (called adjusted or corrected Usually, daily treatment is essential and lifelong.
However, post-surgical HPTH may resolve. The level of calcium in your blood will need to be checked to work out the best treatment plan.
Low calcium (hypocalcaemia)
If symptoms persist or get worse, seek help and Living with hypoparathyroidism
Early symptoms include varying degrees of
Many people with HPTH can expect to lead normal lives ‘inner shaking', dizziness, ‘brain fog', blurred Stopping the tablets altogether can lead to big with a normal life span. vision, irritability, sensitivity to sounds, swings in calcium levels. Do not do this on your With permanent but mild HPTH, temporary diarrhoea, anxiety, extreme weakness, chills, symptoms may occur from time to time. headache. ‘Tetany' is involuntary contraction Severe HPTH is rare but you may experience of muscles and this may progress to seizures. Taking Tablets
constantly unstable calcium levels (or brittle HPTH ) Symptoms can arise through, or be made Always carry spare medication with you. and a range of symptoms which can be very worse by, anxiety and over-breathing. It is Try to maintain a month's supply in reserve. challenging. You should be referred to a specialist important to remain calm. Carry an extra supply of medication on holiday. in calcium metabolism. Most mild symptoms usually pass. Carry your medication in your hand luggage You may experience episodes of unusual fatigue or If they don't, try drinking some milk or when travelling by plane, with prescription muscle weakness. At times you will need to allow calcium-fortified orange juice or eating your body to catch up, with extra rest. Women with HPTH can have a healthy pregnancy If after an hour symptoms still do not Does anything affect my calcium level?
and a normal childbirth. Calcium, vitamin D and improve, take an extra calcium tablet. Diet: It is better to get your calcium from your
thyroid hormone doses may need adjusting Stay calm and keep warm. Calcium tablets food than from supplements. However, some throughout pregnancy. take about 20 minutes to work. foods, e.g. too much wholemeal bread, spinach You may need extra medication during strenuous Sometimes you may just need to take or tomatoes, alcohol and fizzy drinks can physical exercise. Rarely, with severe HPTH, exercise some of your day's dose a little earlier deplete calcium. Dehydration also affects may be difficult with bone pain and muscle than usual without actually taking more. calcium levels: drink eight glasses of water daily. weakness. Try to be gently active. If this keeps happening you should get a Calcium levels can be affected by: illness, blood test as it might mean your infection, fever, sweating, vomiting, diarrhoea, Further information and support are available from medication needs adjusting. dehydration, surgery (including dental), stress, Hypoparathyroidism UK, a national voluntary
If you feel severely unwell or there is a smoking, menstrual periods, menopause organisation, working to support people with sudden onset of severe symptoms, don't (oestrogen affects calcium), exercise, and various hypoparathyroidism and other rare parathyroid wait, take extra medication and call your medications (e.g. iron, aspirin, diuretics, conditions and to promote better medical doctor. You need to take sufficient extra bisphosphonates, beta-blockers, PPI's). understanding. Hypoparathyroidism UK offers a website, medication to prevent a crisis. An a telephone helpline, and free membership that includes an online forum and newsletters. emergency injection of calcium may be What kind of medical support will I need?
needed if your calcium levels have Endocrinologist: Initial visits at the outpatient
dropped very low to prevent spasms department may be frequent (about 3 monthly), then 6-12 monthly visits afterwards. +44(0)1342 316315 +44(0)1623 750330 GP: Your GP will continue to provide advice in-
High calcium (hypercalcaemia)
between visits. Your GP will issue repeat Warning signs include thirst, frequent
6 The Meads, East Grinstead, prescriptions. You are entitled to receive your West Sussex, RH19 4DF urination, severe headache and nausea, medication free of prescription charges. Your GP stomach ache, depressed mood, constipation, needs to endorse your entitlement. This leaflet has been prepared by the HPTH UK Clinical
extreme fatigue, heavy, painful limbs, MedicAlert: We recommend that you wear a
Advisory Team and HPTH UK in conjunction with The
confusion. None of the symptoms are specific MedicAlert bracelet. Hypoparathyroidism UK Society for Endocrinology. HPTH UK Clinical Advisory
and may be due to conditions other than members are entitled to a 5% discount. Team is a group of Endocrinologists with an interest in the parathyroid glands and calcium metabolism who advise HPTH UK on medical matters. Mild symptoms may be averted by
Renato Parascandolo La televisione oltrela televisione Questo volume è stato pubblicato Prefazione di Remo Bodei in collaborazione con l'Istituto italianoper gli Studi filosofici La televisione oltre la televisione I edizione: febbraio 2000© Copyright Editori Riuniti via Alberico II, 33 - 00193 RomaISBN 88-359-4845-2 Parte prima. Questioni di sfondo Internet versus televisioneL'illusione totalitaria, p. 14 - Il «tempo» dei media, p. 15 - L'in-terazione tra i media, p. 17 - Il vizio «mediacentrico», p. 19.