Appropriate Intravenous Doses of L-Thyroxine and Magnesium in a Thyroidectomized Patient with Thyroid and Parathyroid Carcinomas Receiving Total Parenteral Nutrition During Acute Necrotizing Pancreatitis

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Abstract

A totally thyroidectomized patient with thyroid and parathyroid carcinomas, which had developed after neck irradiation in childhood, became hypercalcemic due to pulmonary metastases. The hypercalcemia was ameliorated by intermittent iv administration of bisphosphonate for 3.5 years, but this gradually became refractory to the bisphosphonate treatment. After right thoracotomy for resection of pulmonary metastases, acute necrotizing pancreatitis developed. The patient was therefore placed on total parenteral nutrition supplemented with T<sub>4</sub> and a restricted dose of magnesium. Thyroxine(T<sub>4</sub>) (30 μg/day, iv) was not sufficient to maintain euthyroidism, but a higher dose (60 μg/day) elicited mild hyperthyroidism to the same extent as that elicited by an oral dose of 100 μg/day. The present case showed that the appropriate iv dose of T<sub>4</sub> in this thyroidectomized patient with acute pancreatitis was about 60% of the oral dose. Furthermore, bisphosphonates (pamidronate and alendronate) and magnesium depletion were very effective in controlling the hypercalcemia.<br>(Internal Medicine 34:176-182, 1995)

Journal

  • Internal Medicine

    Internal Medicine 34(3), 176-182, 1995-03-01

    The Japanese Society of Internal Medicine

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