Calcificações cerebrais por hipoparatireoidismo: considerações sobre o diagnóstico, longo tempo após a tireoidectomia

Abstract

The diagnosis of hypoparathyroidism with neurological findings occurring years after thyroid surgery is considered to be rare. The authors describe 3 cases of hypoparathyroidism associated to brain calcifications diagnosed many years after partial thyroidectomy. Two patients were admitted to Emergency Services presenting with seizures, without a previous diagnosis of hypoparathyroidism. The diagnosis was suspected adding the biochemical analysis to the scar on the neck. The CT, which was performed more than 20 years after surgery, showed large cerebral calcifications in both cases. The third patient did not have neurological symptoms, but presented basal and cerebellar calcifications that were demonstrated in the CT. All patients were treated with calcium and vitamin D with great improvement of clinical status. Adding to a case published previously, we count 4 cases from the same region. Thyroidectomies were very common in this region poor in dietary iodide. Since the clinical follow up was inadequate, we suspect that undetected cases similar to these may exist in the present moment.

Hypoparathyroidism and pseudohypoparathyroidism: etiology, laboratory features and complications

“…All of these are consequences of the muscle hyperexcitability caused by extracellular hypocalcemia (2,5). Other described manifestations are soft tissue calcification, as in basal ganglia; psychiatric symptoms such as depression; cataract; and alopecia, among others (7,8).…”

Síndrome de Fahr: um relato de caso

“…O tratamento de escolha enaltecido pelas referências se baseia na normalização dos distúrbios eletrolíticos do cálcio e do fósforo sob a justificativa de proporcionar uma melhora sintomática precoce e interromper a evolução das calcificações cerebrais (GONCALVES JUNIOR JC, et al, 2006). No caso relatado, o paciente foi prontamente medicado com reposição de Cálcio, inicialmente endovenoso e posteriormente por via oral, através da qual obteve-se uma melhora importante dos tremores, bradipsiquismo, distúrbios da fala e da deambulação em apenas 03 dias.…”