Recurrent hypocalcemia due to postoperative total thyroidectomy: a case report
DOI:
https://doi.org/10.18203/2349-3933.ijam20241020Keywords:
Hypocalcemia, Hypoparathyroidism, Total thyroidectomyAbstract
Hypocalcemia is a common complication following total thyroidectomy, caused by inadvertent damage or removal of the parathyroid glands responsible for calcium regulation. This condition poses a significant challenge in postoperative management, often leading to symptoms such as carpopedal spasm, convulsion, and airway constriction occur during hypocalcemia. Patients undergoing total thyroidectomy require vigilant monitoring of serum calcium levels, especially in the immediate postoperative period. Treatment typically involves calcium to prevent hypocalcemic episodes. Long-term management strategies may include the use of calcitriol. We report 30-years-old Indonesian woman suffer hypoparathyroidism because postoperative total thyroidectomy. For a month she did not have any complaints after being prescribed calcium supplement and levothyroxine. But she has stopped the calcium supplement and levothyroxine for 2 days, then she went to emergency room with stiffness all part of body. This report describes proper education of patients on recognizing symptoms of hypocalcemia and ensuring regular follow-up care are essential to prevent complications and improve quality of life post-thyroidectomy.
References
Qin Y, Sun W, Wang Z, Dong W, He L, Zang T, et al. A Meta-Analysis of Risk Factors for Transient and Permanent Hypocalcemia After Total Thyroidectomy. Front Oncol. 2020;10:614089.
Summers R, Macnab R. Thyroid, parathyroid hormones and calcium homeostasis. Anaesth Intens Care Med. 2017;18:10.
Tartaglia F, Giuliani A, Sgueglia M, Biancari F, Juvonen T, Campana FP. Randomized study on oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy. Am J Surg. 2005;190(3):424-9.
Ross AC, Taylor CL, Yaktine AL, Valle HBD, Breiner H, Bandy A, et al. Dietary Reference Intakes for Calcium and Vitamin D. National Academies Press (US). 2011.
Michels TC, Kell KM. Parathyroid Disorders. Am Fam Physician. 2013;88(4):249-57.
Fong J, Khan A. Hypocalcemia Updates in diagnosis and management for primary care. Can Fam Physician. 2012;58:158-62.
Liamis G, Milionis HJ, Elisaf M. A review of drug-induced hypocalcemia. J Bone Miner Metab. 2009;27(6):635-42.
Sakane EN, Vieira, MCC, Vieira GMM, Maeda SS. Treatment options in hypoparathyroidsism. Arch Endocrinol Metab. 2022;66(5)651-7.
Huget I, Munoz M, Cortes M, Romero M, Varsvasky M, Gomez J. Postoperative thyroid hypocalcemia diagnosis management protocol. Rev Osteoporos Metab Miner. 2020;12(2):71-6.
Muncie HL Jr. Weight-Based Levothyroxine Dosage Adjustment for Hypothyrodism. Am Fam Physician. 2022;105(1):6-7.
Azmi NL, Ismail WFW, Azlan WMWM. The Effect of Calcium Supplements on Levothyroxine after Total Thyroidectomy: Result from a Single Centre, Retrospective Study in Kelantan, Malaysia. Int Res J Pharm Med Sci. 2023;6(2):1-4.
Ketteler M, Chen K, Gosmanova EO, Signovovitch J, Mu F, Young JA, et al. Risk of Nephrolitiasis and Nephrocalcinosis in Patients with Chronic Hypoparathryroidism: A Retrospective Cohort Study. Adv Ther. 2021;38(4):1946-57.
Singh N, Singh PN, Hershman JM. Effect of Calcium Carbonate on the Absorption of Levothyroxine. JAMA. 2000;283(1):2822-5.