Endocrine Abstracts

Introduction: Hypocalcemia is defined as a decreased level of calcium in the blood. The presentation of hypocalcemia varies widely, from asymptomatic to life-threatening. The most common cause of chronic hypocalcemia is postsurgical hypoparathyroidism. This may occur after removal of all parathyroid tissue during thyroidectomy and radical neck dissection for malignancies or after inadvertent interruption of the blood supply to the parathyroid glands during head and neck surgery. Here we report the case of an elderly patient with hypoparathyroidism after hemithyroidectomy who developed clinical manifestations of severe hypocalcemia and her life was saved through a tracheostomy.

Case Presentation: A 72-year-old woman was admitted to Mikaelyan University hospital with shortness of breath. She spoke with difficulty, in syllables. The patient’s general condition was extremely heavy and she was admitted in ICU department. She had a history of hemithyroidectomy 30 years ago. The patient had a disorder of consciousness, perioral paresthesia and tingling of the fingers during these years. For this, she was started treatment with calcium 1–3 g/daily, vitamin D3 5000U daily for 10 years and L-thyroxin 25 mcg for 5 years. She had a history of acute respiratory infection 1 month before admission. On admission, examination revealed Ps=122 bpm, BP=160/85 mmHg, T=36.5 °C, SpO₂ 95% (15 liter/min O₂+), BMI=27.5 kg/m². Trousseau and Chvostek signs were positive. Electrocardiogram revealed a prolonged QTc interval. The patient received first medical aid with oxygen, dexamethasone, euphyllin. After the results of blood chemistry, which showed low serum corrected calcium level (1.80 mmol/l), calcium gluconate 10% 10 ml IV was added to the treatment. Unfortunately, the patient’s condition didn’t improved on treatment and she even could not be intubated because of laryngospasm, that’s why tracheostomy was performed. Endocrine examinations showed: 25(OH)D-39.66 ng/ml (n 30−70), parathormone-6.54 pg/ml (n 15−65), TSH-0.939 uIU/ml (n 0.3−4.5), FT4-15.07 pg/ml (n 8.9−17.2). She was diagnosed with postoperative hypoparathyroidism. She continued treatment with calcium gluconate, dexamethasone, L-thyroxine and started treatment with calcitriol 0.25 mcg. The patient improved on this treatment; the tracheostomy was removed after 2 weeks. She was discharged in good general health condition and was advised to continue L-thyroxine, calcitriol therapy with the same dose, calcium 1 g/daily and check serum corrected calcium level in 1 week.

Conclusion: This case report showed that severe hypoparathyroidism can develop even after hemithyroidectomy and lead to life-threatening hypocalcemia requiring emergency procedures. Screening programs for patients with thyroidectomy could help to prevent these life-threatening complications.