title: Calcium and its regulating hormones in patients with graves disease: sex differences and relation to postoperative tetany.
abstract: OBJECTIVE
  To find out why female sex is the most important risk factor for tetany, as calcium and bone metabolism may differ between the sexes.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Thyroid centre, Japan.
  
  
  METHODS
  45 men (mean age 35 years, SD 13) and 178 women (mean age 33 years, SD 12) with Graves disease treated by subtotal thyroidectomy.
  
  
  METHODS
  Measurement of serum concentrations of intact parathyroid hormone (iPTH), calcium, electrolytes, 25-hydroxyvitamin D (25 (OH) D), and 1,25-dihydroxyvitamin D (1,25 (OH) 2D).
  
  
  METHODS
  Mean values of these substances, together with reductions in serum calcium concentration, relative youth, increased alkaline phosphatase activity, large goitre, and increased serum TSH binding inhibitory globulin concentration.
  
  
  RESULTS
  Women had significantly lower calcium concentrations than men (mean (SD) 2.37 (0.13) compared with 2.43 (0.07), p = 0.003). Serum calcium concentrations correlated significantly with concentrations of 25 (OH) D (p < 0.001). 121 of the women (68%) compared with 13 (29%) of men had vitamin D deficiency as defined as 25 (OH) D < 25 nmol/l (p < 0.05). 15 patients (8%) developed tetany postoperatively compared with I man (2%, p = 0.2).
  
  
  CONCLUSIONS
  Women with Graves disease are more susceptible to calcium and vitamin D deficiency than men, which may account for the higher incidence of postoperative tetany among women with the disease.
authors.affiliation: Noguchi Thyroid Clinic and Hospital Foundation, Beppu Oita, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yamashita
authors.forename: S
authors.initials: S
authors.lastname: Noguchi
authors.forename: T
authors.initials: T
authors.lastname: Murakami
authors.forename: S
authors.initials: S
authors.lastname: Uchino
authors.forename: S
authors.initials: S
authors.lastname: Watanabe
authors.forename: A
authors.initials: A
authors.lastname: Ohshima
authors.forename: H
authors.initials: H
authors.lastname: Kawamoto
authors.forename: M
authors.initials: M
authors.lastname: Toda
authors.forename: H
authors.initials: H
authors.lastname: Yamashita
mesh_terms: D015652:25-Hydroxyvitamin D 2 / Q000097:blood; D000328:Adult; D002118:Calcium / Q000097:blood*; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013746:Tetany / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D013965:Thyroidectomy
chemical_list: D010281:Parathyroid Hormone; D015652:25-Hydroxyvitamin D 2; D002118:Calcium