Studies of Calcium and Phosphorus Metabolism. Xx. The High Calcium Excretion in Exophthalmic Goiter Is Not Due to Vitamine D Deficiency

Abstract

In previous publications of this series (1,2), it has been demonstrated that exophthalmic goiter is associated with a calcium and phosphorus excretion elevated in excess of the increased general metabolism. Several conditions have a high urinary calcium excretion. As far as is now known, such a high calcium output when elevated in both urine and feces is found only in hyperthyroidism and vitamine D deficiencies (3). A patient with osteomalacia, carefully studied by Gargill, Gilligan, and Blumgart (4), showed an analogous high urinary and fecal calcium excretion, which returned to normal after large doses of vitamine D. It was, therefore, of interest to determine whether hyperthyroid cases, because of the elevated metabolic demand, could be suffering from vitamine D deficiencies due to an increased need for vitamines. The idea gains some support in the work of Plimmer (5) of Cowgill and Klotz (6) and of Himwich, Goldfarb and Cowgill (7), which indicates that the amount of vitamine B required by the organism is determined chiefly by its caloric requirement. In hyperthyroidism the publications of McCarrison (8) have directed attention to the relation of diet and hyperthyroidism, and Rabinowitch (9) and Fraser and Cameron (10) have published observations which suggested that the addition of vitamines A and D to iodine gave a somewhat greater improvement in Grave's disease, than did iodine alone. In the following observations, this problem was studied by giving irradiated ergosterol to hyperthyroid patients who were maintained on an otherwise constant regime. METHODSThe same careful metabolic routine fully described in previous publications (11), was followed. Further descriptions of this technic need not be added here. The diet was essentially neutral in its acid-base contents as calculated from Sherman's tables (12). The constituents were similar to those of Table VII in paper XI of this series (13), though the total amounts were increased to conform with the caloric needs of 1273

The effect of desiccated thryroid, irradiated ergosterol and ammonium chloride on the excretion of calcium in rats

“…In experiments not reported herein, we have found that the injection of parathyroid extract into rats receiving desiccated thyroid increases the total loss of calcium from the body. The failure of Tibbetts et al [1932] to observe a reduction in faecal calcium excretion and negative calcium balance, as we did, after administration of vitamin D, may perhaps be ascribed to inadequate dosage; Taylor and Weld [1932] obtained results similar to ours in dogs.…”

“…[1932] found that demineralisation of the skeleton occurred in dogs during thyroid feeding and was not increased by simultaneous administration of parathyroid extracts. Tibbetts et al [1932] announced that the high faecal excretion of calcium in clinical hyperthyroidism was not influenced by administration of irradiated ergosterol; Watchorn [1930], Pugsley [1932] and others have found however that irradiated ergosterol tends generally to decrease the faecal and increase the urinary excretion of calcium. The present paper reports a study of the effect of desiccated thyroid on the calcium excretion of rats and the influence of irradiated ergosterol' thereon, while some experiments on the effect of ammonium chloride acidosis are included for comparison.…”

Metabolic Observations in a Case of Thyrotoxicosis With Hypercalcemia*

“…In contrast to the rarity of clinical manifestations, the characteristic abnormality of calcium metabolism-excessive loss in both urine and feces-is frequently observed (3,7,8,25,26). Aub and associates (3) studied 14 patients with thyrotoxicosis who were given a low calcium diet.…”

Magnesium Metabolism in Health and Disease. Iii. In Exophthalmic Goiter, Basophilic Adenoma, Addison's Disease and Steatorrhea

“…The remainder of the metabolic data on these patients can be found in a previous publication (8) and are, therefore, not repeated here. In these two patients with enormously high 'calcium and phosphorus excretions, the magnesium output is no higher than in our normal controls (7)-in fact, the fecal excretion is somewhat lower and both subjects stored magnesium.…”