Endocrine Abstracts

Background: Transient thyroiditis following parathyroidectomy, although uncommonly documented, can arise from various etiologies such as autoimmune disorder, infections and other post inflammatory states, commonly with Immunotherapy. Post-surgical thyroiditis, including cases post-parathyroidectomy, is not fully elucidated in terms of its mechanisms. Herein, we present two cases of transient thyroiditis post-parathyroidectomy, highlighting the divergent outcomes and thereby the need for specialist monitoring.

Case Report: Patient A, who underwent right inferior parathyroidectomy, developed sudden onset palpitations diagnosed as Fast Atrial Fibrillation, accompanied by a paired TSH and T4 of 0.05 and 41, respectively (Normal Values: TSH: 0.27 - 4.5 mU/l, T4: 11 – 23 pmol/l), a week after surgery. Patient B, who underwent inferior parathyroidectomy with total thymectomy, experienced worsening loose stools and palpitations, revealing a paired TSH and T4 of 0.03 and 31.5, respectively. After ruling out autoimmune factors, both cases were attributed to post-parathyroidectomy transient thyroiditis, illustrating the variable clinical presentations and outcomes of this condition. Subsequent symptomatic treatment for transient thyroiditis led to symptom resolution, with thyroid function tests (TFTs) revealing improved FT4 levels. Consequently, anti-thyroid medications were gradually reduced for both patients and eventually stopped. Patient A achieved complete recovery with stable TFTs. However, patient B developed symptomatic hypothyroidism (TSH 6.6, FT4 10.3) despite discontinuation of anti-thyroid medications six weeks earlier, with positive TRAb(TSH Receptor Antibody), that was initially negative. Consequently, Levothyroxine was initiated for management. This emphasizes the importance of continuous monitoring and personalized intervention in post-parathyroidectomy thyroiditis to address the variable outcomes.

Discussion and Conclusion: : Transient thyroiditis following parathyroidectomy presents with contrasting clinical outcomes, underscores the complexity of its management. While autoimmune factors were ruled out in our cases, the pathogenesis of post-parathyroidectomy thyroiditis remains unclear. Inflammation related to palpation and mobilisation intraoperatively are thought to mediate these changes. Similar cases of post-parathyroidectomy transient thyroiditis are scarcely documented online, reflecting the rarity of this condition. Given the potential for variable outcomes, close follow-up and individualized management are imperative.