Hypocalcaemia following thyroidectomy unresponsive to oral therapy.
Hypocalcaemia due to hypoparathyroidism following thyroidectomy is a relatively common occurrence. Standard treatment is with oral calcium and vitamin D replacement therapy; lack of response to oral therapy is rare. Herein we describe a case of hypoparathyroidism following thyroidectomy unresponsive to oral therapy in a patient with a complex medical history. We consider the potential causes in the context of calcium metabolism including: poor adherence, hungry bone syndrome, malabsorption, vitamin D resistance, bisphosphonate use and functional hypoparathyroidism secondary to magnesium deficiency. Malabsorption due to intestinal hurry was likely to be a contributory factor in this case and very large doses of oral therapy were required to avoid symptomatic hypocalcaemia.
Department of Diabetes and Endocrinology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Zac C
ZC
Etheridge
Nottinghamshire Healthcare NHS Trust; Nottingham University Hospitals NHS Trust; Nottingham, UK.
Christopher
C
Schofield
Department of Clinical Pathology, Nottingham University Hospitals NHS Trust; Nottingham, UK.
Peter J J
PJ
Prinsloo
Department of Diabetes and Endocrinology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Nigel D C
ND
Sturrock
D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D002117:Calcitriol / Q000008:administration & dosage*; D002119:Calcium Carbonate / Q000008:administration & dosage*; D019355:Calcium Citrate / Q000008:administration & dosage; D002125:Calcium Gluconate / Q000008:administration & dosage; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000008:administration & dosage; D006996:Hypocalcemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D007011:Hypoparathyroidism / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012307:Risk Factors; D013965:Thyroidectomy / Q000009:adverse effects*; D013997:Time Factors; D017211:Treatment Failure
D006887:Hydroxycholecalciferols; D002117:Calcitriol; D002119:Calcium Carbonate; D019355:Calcium Citrate; D002125:Calcium Gluconate; C008088:alfacalcidol