Endocrine Abstracts

Introduction: Hypocalcemia varies from asymptomatic biochemical abnormality to life-treating disorder, depending on the duration, severity and rapidity of development.

Case report: A 77-year-old woman was admitted for study of asymptomatic hypocalcemia discovered in routinely laboratory test. Past medical history, left thyroidectomy by goiter 53 year ago without follow-up. She denied any symptoms. Physical examination. Actinic keratosis in right cheek, scar of thyroidectomy. Cardiac and respiratory exam were normal. Neurologic examination discards abnormalities, Chvostek and Trousseau signs were negatives. Laboratory test; calcium 5.72 mg/dl, phosphate 5.67 mg/dl, ionized calcium 3.1 mg/dl, magnesium 1.60 mg/dl, albumin 3.7 g, PTH 2.6 pg/ml, urinary calcium 12.2 mg/24 h, D3, TSH, cortisol, ACTH, hepatic and renal test normal. Thyroid Ab negatives. EKG normal. CT of the neck an brain, normal thyroid remnant, calcifications of basal ganglia and the corona radiata. Skeletal X-ray degenerative lesion age related. Treatments with calcium carbonate 2.5 g. TID and calcitriol 0.25 μg BID were initiated. Follow-up, one month later calcium level 8.5 mg/dl and phosphate 3 mg/dl. Currently patients remain asymptomatic with calcium 2.5 g and calcitriol 0.25 μg daily.

Discussion: The incidence of hypocalcemia varies from 0.4–13.8% after total thyroidectomy to 0.2–1.9% after subtotal thyroidectomy. Chronic or moderate hypocalcemia may be asymptomatic. Clinical signs are observed only with decreases in ionized calcium concentration in our patient despite low level ionized calcium was asymptomatic probably due to duration of hypocalcemia. Chronic hypocalcemia is treated by calcium oral and vitamin D supplementation. The serum calcium level should be targeted to about 8.0 mg/dl. Cerebral calcifications are not reversible.

Conclusion: Periodical routine checks of calcium levels in patients undergoing thyroid surgery would allow early diagnosis of asymptomatic hypocalcemia.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.