A Case of “Late” Postsurgical Hypoparathyroidism

Simões, Carla; Costa, Marcella Karen Souza da; Comerlato, L. B.; Ogusco, A. A.; Filho, Veras; Dedivitis, Rogério Aparecido; Cernea, Cláudio Roberto

doi:10.1155/2017/3962951

Cited by 3 publications

(1 citation statement)

References 3 publications

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“…This phenomenon of delayed hypoparathyroidism is usually thought to occur secondary to progressive atrophy of the parathyroid glands. Another possible explanation is scar tissue formation in the parathyroid glands causing late onset retraction of scar tissue leading to worsening of hypovascularization and slowly progressive ischemia [ 8 , 9 ]. Parathyroid vasculature undergoing arteriosclerotic changes in an elderly patient leading to infarction or atrophy of the remaining parathyroid tissue has also been described as a possible underlying mechanism for this late occurrence of the condition [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Delayed Hypoparathyroidism following Thyroidectomy, a Diagnostic Conundrum: A Report of Three Cases from Sri Lanka

Wijewickrama

Rajaratnam

2020

Case Reports in Endocrinology

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Introduction. Hypoparathyroidism, which is a common complication following total thyroidectomy can be transient in majority and permanent in 1.5% of the patients and usually occurs secondary to an inadvertent removal of parathyroid glands, mechanical or thermal injury or disruption of the vasculature. In some patients, it is observed that symptoms of hypocalcemia can occur for the first time several years after the surgery, which is known as “delayed hypoparathyroidism.” We report three cases of delayed hypoparathyroidism from Sri Lanka, presenting several years after total thyroidectomy. Case Presentation. Case 1- a 60-year-old Sri Lankan woman who presented with symptomatic hypocalcemia for the first time, 30 years after total thyroidectomy for follicular thyroid carcinoma. Case 2- a 53-year-old Sri Lankan woman presenting with neuropsychiatric manifestations of hypocalcemia for the first time, 12 years after total thyroidectomy for papillary thyroid carcinoma. Case 3- a 49-year-old Sri Lankan woman developing symptoms of hypocalcemia for the first time, 11 years after completion of thyroidectomy for papillary thyroid carcinoma. All these patients were detected to have low parathyroid hormone levels, without an alternative etiology for hypoparathyroidism, hence leading to a diagnosis of delayed post-thyroidectomy hypoparathyroidism. Conclusion. Delayed hypoparathyroidism is a rare phenomenon, which is secondary to progressive atrophy of parathyroid glands and slowly progressive hypovascularization of parathyroids due to scar tissue retraction following thyroidectomy. The nonspecific nature of hypocalcemic symptoms and lack of continuous follow-up for a long time after thyroidectomy could contribute to a further delay in diagnosis. However, it is an important diagnosis to consider in any patient with a history of neck surgery presenting with hypocalcemia, irrespective of the time duration of surgery, as timely diagnosis and treatment can prevent long-term complications of hypocalcemia and improve the quality of life.

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Section: Discussionmentioning

confidence: 99%

Delayed Hypoparathyroidism following Thyroidectomy, a Diagnostic Conundrum: A Report of Three Cases from Sri Lanka

Wijewickrama

Rajaratnam

2020

Case Reports in Endocrinology

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Late-onset postsurgical hypoparathyroidism following parathyroidectomy for recurrent primary hyperparathyroidism: a case report and literature review

et al. 2020

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Purpose Previously in 1987, a 21-year-old-male was diagnosed with primary 20 hyperparathyroidism (PHPT) when a right inferior parathyroid adenoma was removed. PHPT 21 recurred after three and six years and on both occasions was cured by resection of parathyroid 22 adenomas. At 52-years-of-age, the patient developed a late-onset hypoparathyroidism (HP), 23 even though postsurgical HP typically occurs as a transient or permanent form soon after neck 24 surgery. The purpose of this work was to report the follow-up of the patient and to review prior 25 cases of late-onset postsurgical HP. 26 Methods Prior cases of late-onset postsurgical HP were searched and reviewed focusing on 27 clinical and biochemical features.28 Results The patient's asymptomatic hypocalcemia with total serum calcium at 8.2 mg/dL was 29 initially documented in September 2018; PTH was inappropriately low at 15 ng/mL. In

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Differential diagnosis of idiopathic hypoparathyroidism: a case series

et al. 2021

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Идиопатический гипопаратиреоз -редкое эндокринное заболевание, устанавливаемое при исключении всех возможных причин развития гипопаратиреоза. На сегодняшний день данные о распространенности идиопатического гипопаратиреоза ограничиваются рядом локальных исследований среди населения отдельных стран. Разнообразие клинических проявлений гипопаратиреоза, схожесть с проявлениями ряда других патологий, в частности, эпилепсии, значимо удлиняют путь пациента до постановки правильного диагноза и назначения патогенетической терапии. Учитывая осведомленность клиницистов различного профиля о хирургическом гипопаратиреозе и редкость идиопатической формы в клинической практике, становится понятным, что отсутствие хирургического вмешательства на органах шеи в анамнезе практически исключает гипопаратиреоз из дифференциального поиска. При подтверждении гипопаратиреоза нехирургической этиологии необходимо применение всех известных на сегодняшний день диагностических ресурсов для уточнения этиологии заболевания. В статье представлена серия клинических случаев, отражающих сложность диагностики и особенности течения идиопатического гипопаратиреоза. Рассмотрены имеющиеся в настоящее время методы диагностики, в частности, определение уровня интерферона-омега при подозрении на аутоиммунный полигландулярный синдром 1 типа как наиболее распространенную причину нехирургического гипопаратиреоза.

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A Case of “Late” Postsurgical Hypoparathyroidism

Cited by 3 publications

References 3 publications

Delayed Hypoparathyroidism following Thyroidectomy, a Diagnostic Conundrum: A Report of Three Cases from Sri Lanka

Delayed Hypoparathyroidism following Thyroidectomy, a Diagnostic Conundrum: A Report of Three Cases from Sri Lanka

Late-onset postsurgical hypoparathyroidism following parathyroidectomy for recurrent primary hyperparathyroidism: a case report and literature review

Differential diagnosis of idiopathic hypoparathyroidism: a case series

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