Endocrine Abstracts

Introduction: Postoperative hypoparathyroidism is a frequent complication of total thyroidectomy that must be detected and treated. The resulting hypocalcemia is quite severe and usually occurs in the first few days or weeks after surgery.Herein, we describe a case of chronic asymptomatic hypocalcemia related to postoperative hypoparathyroidism diagnosed years after total thyroidectomy.

Observation: We report the case of a 61 year old woman, who had a total thyroidectomy in 1997 for papillary carcinoma and was lost to follow up after surgery. She was referred to the endocrinology department (24 years later) to explore asymptomatic hypocalcemia (1.47 mmol/l) discovered incidentally in a biological check-up. She had no family or personal history of autoimmune disease. Physical examination showed no abnormalities but the electrocardiogram suggested prolongation of the Q-T interval. The patient was treated with i.v. infusion of calcium gluconate. Laboratory tests revealed, a controlling serum calcium: 1.65 mmol/l (55 mg/l), phosphate: 2.56 mmol/l (80 mg/l), PTH levels: 12 pg/ml. Further exploration showed long-term complications of hypoparathyroidism: a Fahr’s syndrome on the CT scan of the brain, dental anomalies, bilateral sub capsular cataract but no renal calcifications. The diagnosis of chronic hypocalcemia secondary to postoperative hyoparathyroidism was retained. She was put on calcium gluconate and alfacalcidol.

Conclusion: This case present a rare presentation of chronic asymptomatic hypocalcemia diagnosed 24 years after thyroid surgery and probably due to postoperative hypoparathyroidism.