Endocrine Abstracts

Introduction: Hypocalcemia in post-operative hypoparathyroidism responds to oral vitamin D and calcium replacement. We describe a case of persistent symptomatic hypocalcemia and hypothyroidism despite oral replacement and management with supervised weekly supplementation.

Case history: A 56-year-old lady had total thyroidectomy for multinodular goitre. Persistent post-operative hypoparathyroidism and hypothyroidism necessitated replacement with calcitriol 1500 ng, calcium carbonate 3 g and thyroxine 225 μg daily. She had recurrent emergency admissions with carpopedal spasms due to hypocalcemia and hypomagnesemia. In addition, her TSH remained high. She insisted she was compliant with medications. We excluded other possible causes including malabsorption and hepatic enzyme induction. She was tried on alternative formulations of vitamin D without benefit.

In ‘desperation’, we started weekly supplementation of intravenous Calcijex 12 mcg, 1200 mcg thyroxine and calcichew 20 tablets in our programmed investigations unit supervised by the endocrine specialist nurse. This normalised her calcium and TSH levels.

Conclusion: Non compliance with medication poses a challenge in managing chronic conditions. Specialist nurses may play a role in managing weekly-supervfised replacement in such patients. This is cost effective in selected patients by avoiding admission due to acute complications