Efficacy of teriparatid therapy in resistant hypocalcemia depending postoperative hypoparathyroidism

Buğra Durmuș; Gülsüm Karaahmetli; Müge Keskin; Balsak Belma Tural; Hüsniye Bașer; Dilek Berker

doi:10.1530/endoabs.70.AEP224

Objective: While postoperative hypoparathyroidism can usually be controlled with elemental calcium (Ca) and calcitriol therapy, rarely this treatment may be inadequate and teriparatid therapy may be used as an alternative. In the literature, it is reported that teriparatid therapy is effective and reliable in the treatment of patients with postoperative hypoparathyroidism, as well as improving quality of life and reducing the frequency of hospitalization. In this report, we present a case of postoperative hypoparathyroid disease that was followed up due to treatment resistant hypocalcemia and responded to teriparatid therapy.

Case: 41 - year-old female patient, 3 years ago due to papillary thyroid carcinoma after total thyroidectomy developed in the hands-feet with numbness and tingling complaints were admitted to the outpatient clinic. Serum total calcium: 4.9 mg/dl, phosphate:5.5 mg/dl, intact PTH:0.7 ng/l were determined and oral Ca and calcitriol treatment was started after the diagnosis of postoperative hypoparathyroidism. Although calcitriol was given 6 mg/day, elemental Ca 15 gr/day dose, Ca values remained at 6.5–7 mg/dl (Table 1) level after the patient received replacement therapy for approximately 2 months. The patient’s complaints continued clinically and the patient was hospitalized several times due to the need for intravenous Ca. Subcutaneous teriparatide acetate (recombinant human parathyroid hormone 1–34) was administered once a day at a dose of 20 µg/80 µl in addition to the existing treatment of the patient who did not respond to the treatment. Calcitriol requirement decreased to 2 mg/day and elemental Ca requirement decreased to 6 g/day according to Ca follow-up after Teriparatid treatment. After treatment, the patient’s total serum Ca value increased to 8.2 mg/dl and the patient’s hypocalcemia symptoms improved.

**Table 1** Laboratory values before and after teriparatid treatment of the patient.
Laboratory parameters / Normal value range	Postoperative basal values	After initial dose of Ca and Calcitriol	After maximum dose of Ca and Calcitriol	After teriqaratid therapy
Serum total calcium (8.7 – 10.4 mg/dl)	4.99	6.84	7	8.2
Serum phosphate (2.4 – 5.1 m g/d l)	5.56	5.78	4.48	4.5
Serum intact PTH (18.4 – 80.1 ng/l)	0.7	4,9	4.6	5.8
25-0H Vitamin D (25 – 80 ng/m l)	45.6	31.8	31.6	205
Serum alkaline phosp hate (53 – 128 U/l)	56	52	37	52
Serum albmin (32 – 48 g/l)	42.7	38.8	37.7	38
Serum magnesium (1.3 – 2.7 mg/d l)	1.64	1.89	1.73	1.68
24 hr urine calcium (100–300 mg/day)	211.9	–	202	–
24 hr urine phosphate (0.4–1.3 mg/day)	0.542	–	0.297	–

Conclusion: It should be noted that recombinant human teriparatid therapy may be effective in patients with postoperative hypoparathyroid disease, which requires intravenous calcium infusion and hospitalization despite high doses of calcium and calcitriol therapy, and treatment change should not be delayed.

Endocrine Abstracts

AEP224