Background: Hypoparathyroidism is an uncommon disorder of calcium metabolism characterized by hypocalcemia, hyperphosphatemia, and reduced level of parathyroid hormone (PTH). The most common cause of hypoparathyroidism is accidental damage to the parathyroid glands during thyroid surgery. There are no formal guidelines for hypoparathyroidism management. The main goal of treatment is to improve the symptoms of hypocalcemia, to keep the serum calcium within the low normal range, and to avoid hypercalcemia. Herein we report a case of hypoparathyroidism, which was successfully treated with subcutaneous teriparatide.
Case report: A 38-year-old woman presented to our clinic with tetany. The patient had symptoms of perioral numbness, paresthesias of the hands and feet, muscle cramps, and Chvostek’s sign was positive. It was learned that one year before admission, the patient underwent a total thyroidectomy due to multinodular goiter, and treatment was given for hypoparathyroidism related to post-surgical hypoparathyroidism. The patient, who received 6 gr calcitriol and 12 gr calcium carbonate treatment, was hospitalized with the diagnosis of resistant hypoparathyroidism. The laboratory values were PTH:1 pg/dl, Ca:6.1 mg/dl, phosphorus: 5.1 mg/dl. Normocalcemia was achieved, and hypocalcemia signs and symptoms regressed with intravenous calcium treatment. 25(OH)D and hydrochlorothiazide treatment were added to the treatment of the patient, and calcium carbonate treatment was started to be given as 2 g at 4-hour intervals. Despite treatment changes, the patient’s calcium level was found to be 7.8 mg/dl. Teriparatide treatment was started for the patient who stated that using high dose calcium treatment affects the quality of her life. The patient was started on 2*20 mg teriparatide treatment, and daily serum calcium level control was performed. Calcitriol treatment was discontinued within two weeks, while Ca treatment was reduced to 1 g. Although the patient described mild bone pain lasting up to 1 hour with teriparatide treatment, the patient’s symptoms and signs of hypocalcemia did not recur. The patient, whose treatment was adjusted as 2*20 mg teriparatide and 2 g calcium carbonate, did not need intravenous calcium treatment for six months. Before starting teriparatide treatment, the patient’s 24-hour urinary calcium level was 231 mg/day, and after three months, it decreased to 91 mg/day with teriparatide therapy. Although the patient states that mild bone pain persists, she describes that the quality of life has improved greatly.
Conclusion: Teriparatide is an effective alternative treatment for patients with hypoparathyroidism, which may avoid the potential side effects of conventional therapy.
05 Sep 2020 - 09 Sep 2020