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Thyroid Cancer pp 175–183Cite as

A Case with Postsurgical Hypoparathyroidism

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Abstract

Postsurgical hypoparathyroidism is a disorder characterized by hypocalcemia and low or absent parathyroid hormone (PTH). It is mainly caused by parathyroid devascularization, stunning, or incidental removal of the parathyroid gland(s) during thyroidectomy. The prevalence of postsurgical hypoparathyroidism in the Western world is estimated to be around 22 per 100,000 population. Symptoms probably depend on the degree and rapidity of hypocalcemia onset and are uncommon unless serum calcium level is below 2.0 mmol/L (8.0 mg/dL). These symptoms range from mild paresthesias and tingling to more severe cramps, tetany, seizures, laryngospasm, congestive heart failure, and arrhythmias due to prolonged QT intervals. Fortunately, only a minority of patients with transient hypoparathyroidism proceed to a state of permanent hypoparathyroidism, because of the recovery of the parathyroid glands from the surgical insult. It is currently difficult to predict which patients will recover, and it is unclear as to whether any specific intervention will facilitate recovery. Preoperative serum vitamin D, postoperative serum PTH, and postoperative changes in serum calcium levels should be considered predictors. The aim of hypoparathyroidism treatment is to keep the level of albumin-adjusted serum calcium at the lower end of the normal range to avoid the risk of hypercalcemia and hypercalciuria, which have the potential for renal impairment. For severe transient hypocalcemia, treatment could start with intravenous calcium gluconate. However, for mild hypocalcemia, oral calcium and calcitriol are usually used. Lack of response to oral therapy in the treatment of hypoparathyroidism following thyroidectomy has rarely been reported, and thus it is mandatory to exclude other potential causes of the hypocalcemia.

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Authors and Affiliations

  1. Department of Internal Medicine and Medical Disciplines, “Sapienza”, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Jessica Pepe MD, PhD & Salvatore Minisola MD (Full Professor of Internal Medicine)

Authors
  1. Jessica Pepe MD, PhD
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  2. Salvatore Minisola MD
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Corresponding author

Correspondence to Jessica Pepe MD, PhD .

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Editors and Affiliations

  1. Johns Hopkins University, Baltimore, Maryland, USA

    David S. Cooper

  2. Department of Internal Medicine, University of Rome, Rome, Roma, Italy

    Cosimo Durante

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© 2016 Springer International Publishing Switzerland

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Pepe, J., Minisola, S. (2016). A Case with Postsurgical Hypoparathyroidism. In: Cooper, D., Durante, C. (eds) Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-22401-5_20

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  • DOI: https://doi.org/10.1007/978-3-319-22401-5_20

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22400-8

  • Online ISBN: 978-3-319-22401-5

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