Endocrine Abstracts

Introduction: Dilated cardiomyopathy (DCMP) is a serious and rare complication of unrecognized chronic hypocalcemia, whose etiologies are dominated by hypoparathyroidism. The peculiarity of this DCMP is due to the fact that it is reversible to different degrees after the correction of hypocalcemia. Its incidence is rare because of the early management of any hypocalcemia. The objective of our work is to highlight the interest of screening and treatment of postoperative hypoparathyroidism to avoid DCMP.

Observation: A 62-year-old patient having a history of thyroidectomy 5 years ago receiving 100ug per day of levothyroxine, history revealed dyspnea with tingling and tetany crisis. On examination, his blood pressure was 130/70 mmHg with negative Chvostek and Trousseau sign. The electrocardiogram showed a regular sinus rhythm, a complete left branch block and an extended QT interval. His trans-thoracic ultrasound showed dilated cardiomyopathy, global hypokinesia, and systolic dysfunction with a 20% ejection fraction. In the biological assessment we note: hypocalcemia at 50 mg/l, hyperphosphoremia at 109 mg/l, serum sodium concentration at 140 mmol/l, serum potassium at 3.9 mmol/l and TSH at 17 mIU/l. The patient was treated with intravenous calcium until the normalization of serum calcium with oral relay and active vitamin D supplementation. For his heart failure, he was put on ACE inhibitor in combination with a diuretic. The evolution was marked by an improvement of the cardiac function and o systolic fraction ejection increased to 55%.

Conclusion: Hypokinetic dilated cardiomyopathy is a rare but serious complication of hypocalcemia, which emphasizes the importance of routine phosphocalcic monitoring after thyroid surgery, and the prescription of vitamin and calcium substitution if needed. Its management is based on calcium and active vitamin D substitution, with close cardiological monitoring. Its evolution is marked by the more or less complete regression of heart failure.