Endocrine Abstracts

Case history: A 41-year-old lady had Total Thyroidectomy in 2007 for a large multi-nodular goitre. Post-operatively, she was hypocalcemic with mild inappropriately low Pth levels. She was treated with high dose α-calcidol and calcium supplements but the response was suboptimal. Following introduction of teriparatide, serum calcium has been improving to between 1.90 and 2.06 mmol/l. She continues on high dose α-calcidol.

Investigations: Corrected calcium range in the 6 months preceding pre-teriparatide, 1.71 1.93 mmol/l. Corrected calcium range in the 6 months post T/t, 1.90–2.10 mmol/l. Serum magnesium, normal.

Results and treatment: Teriparatide, 20 mg s.c. daily. α-Calcidol 4–15 mg OD; currently 8 mg OD. Thyroxine currently 200 mg OD.

Conclusions and points for discussion: Post-operative hypoparathyroidism following thyroid surgery occurs in 1–4% of patients. Treatment options include high dose α-calcidol and in the occasional patient use of synthetic human parathormone which could be the truncated hormone teriparatide (1–34) or intact hormone preotact (1–84). 1000 patients are members of Hypoparathyroidism UK of which six are on teriparatide and ten are on preotact. Cost of treatment with either is comparable.

References: Oxford Textbook of Endocrinology, BNF2013. Hypoparathyroidism UK, Prof. William Fraser.