Endocrine Abstracts

Introduction: No consensus guideline on the treatment of hypoparathyroidism. Hypoparathyroidism is a disease characterized by hypocalcaemia and insufficient PTH. Conventional therapy includes calcium and active vitamin D supplementation, often in large doses.

Case report: A 31-year-old woman presented with hypercalcemia. Serum calcium and phosphorus levels were 10.5 and 2.56 mg/dl respectively. The serum PTH level was increased (1619 pg/ml). The serum 25-OH vitamin D level was decreased (3.5 ng/ml). Her past medical history revealed osteoporosis (femur T score −4.0). Parathyroid USG showed left and right parathyroid adenomas. Double adenoma excision from left and right inferior sites and total thyroidectomy was performed. On pathological examination of thyroid was benign thyroid nodules. Double parathyroid adenomas was identified. Postoperative serum calcium level was 5.5 mg/dl. She recieved daily calcium gluconate infusions. Discharge with calcitriol and CaCO₃ with latest calcium level was 6 mg/dl. During follow-up, she was taken to internal medicine ward with symtomatic hypocalcaemia. Serum calcium, phosphorus, PTH, and 25-OH vitamin D levels were 5.2 mg/dl, 3.2 mg/dl, <3 pg/ml, and 5 ng/ml respectively. The doses were progressively increased up to 12 μg/day calcitriol. Under this tretatment serum calcium level was 6.9 mg/dl. Phosphorus level was 3.8 mg/dl. Follow-up, 20 μg teriparatide b.i.d. was added to the treatment. She has used teriparatide for a period of 10 months. At the end of teriparatide treatment, calcitriol reduced to 4.5 μg/day and calcimax D3 reduced 3×1 tb. Final control visit her calcium level was 8.5 mg/dl and phosphorus level was 4.1 mg/dl while taking calcitirol dose of 3.5 μg/day and calcimax D3 dose of 2×2 tb.

Conclusion: In our postoperative hypocalcaemic case, calcitriol dose reduced and calcium level increased after the teriparatide treatment. Teriparatide may be useful in postoperative resistant hypocalcaemia.