Abstract
Following parathyroidectomy, serum calcium decreases to tetanic levels prior to increase of serum phosphorus, thus supporting the concept that parathyroid hormone has a direct skeletal effect and indicating an indirect or delayed action on phosphorus. This problem was evaluated by parallel measurements of serum and urinary calcium and phosphorus in four patients in whom hypoparathyroidism developed following thyroid surgery. In all cases tetanic manifestations preceded elevation of serum phosphorus. A profound fall in phosphorus excretion-demonstrated by a low phosphate clearance (Cp)-occurred soon after surgery. In two subjects with transient tetany, Cp decreased prior to elevation of serum phosphorus and returned to normal before regression of the hyperphosphatemia. In the instances of permanent parathyroid deficiency changes were even more marked; one patient with severe hypocalcemic tetany demonstrated no elevation of serum phosphorus until the third postoperative day; however, Cp was only 0.3 ml/minute on the day after surgery. These studies offer further evidence for a dual action of parathyroid hormone but indicate that changes in phosphorus excretion occur with equal or greater rapidity than those of serum calcium. The delayed elevation of serum phosphorus in hypoparathyroidism can be attributed to the magnitude of the phosphate compartment.
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