Endocrine Abstracts

Post-surgical hypoparathyroidism occurs as inadvertent removal or irreversible damageparathyroid disease, irreversible or permanent causing decreased action of parathormone leading to hypocalcemia and hypophosphatemia.

Clinical Case: A 52-year-old woman referred from our outpatient clinics due to severe hypocalcemia symptomatic; hand and foot cramps, and hyperphosphatemia: albumincorrected calcium. (5.52 mg/dl and phosphate of 6.6 mg/dl). She presents a history of total thyroidectomy in 2021 due to Grave’s disease with severe exophthalmos, which therefore performed a post-surgical hypoparathyroidism. During successive revisions in queries, it persists hypocalcemia despite increasing the dose of your usual treatment: calcium carbonate 6 tablets/day, levothyroxine 100 mg every 24 hours, Calcitriol 0.5 mg 3 tablets daily day, Vitamin D 25000ui monthly. Admission for intravenous calcium replacement was decided, in addition to oral contributions of the same and calcitriol. Dose reduction of intravenous calcium was attempted multiple times to achieve its complete withdrawal but returned to symptomatic hypocalcemia. During admission, a study was started to rule out causes of calcium absorptive deficit, discarding it and modifying the calcium formula to calcium pidolate for a better absorption. A nephrological study was performed to rule out causes of excessive losses due to urine that would justify the poor response to treatment, without detecting kidney disease chronicle. Given the therapeutic failure, other therapeutic alternatives were reviewed, deciding start treatment with Teriparatide (rH-PTH) 20 mg every 24 hours, assessing various satisfactory clinical studies, and proceeding in accordance with the literature and with the consent of the patient to start treatment without specific indication. It was obtained satisfactory response with decreased phosphate levels and elevated calcium in blood; Laboratory tests on discharge: calcium corrected for total protein 8.24, phosphate 3.5, allowing withdrawal of intravenous calcium gluconate and allowing home discharge with this outpatient treatment: Teriparatide 20 mg every 24 hours, Calcitriol 0.5 mg every 12 hours, calcium pidolate 1 over every 8 hours, levothyroxine 100 mg every 24 hours. In the following check-ups, the patient has maintained calcium and phosphate levels within range without any symptoms, maintaining the same treatment with Teriparatide 20 mg every 24 hours.

Conclusions: PTH replacement therapy with rh, PTH regulated mineral homeostasis of calcium and phosphate metabolism towards normality in this patient.