Endocrine Abstracts

JOINT3787

Introduction: Post-thyroidectomy hypoparathyroidism is a well-documented complication, typically presenting within 48 hours of surgery. While most cases are transient, permanent hypoparathyroidism occurs in approximately 1.5% of patients. A rare and underrecognized form, delayed hypoparathyroidism, manifests years after surgery, likely due to progressive ischemia or atrophy of preserved parathyroid glands. This report discusses a case of severe hypocalcemia occurring 15 years after total thyroidectomy.

Case Presentation: A 50-year-old postmenopausal woman was admitted for the management of severe hypocalcemia (54 mg/l). Her medical history revealed a total thyroidectomy performed 15 years earlier for a retrosternal goiter with no immediate postoperative complications. Clinical examination showed a positive Chvostek sign, but the patient was hemodynamically and neurologically stable. Non-parathyroid causes of hypocalcemia were excluded, leading to a diagnosis of delayed post-surgical hypoparathyroidism.

Discussion: This case highlights potential mechanisms for delayed hypoparathyroidism, including progressive hypovascularization and scar tissue formation. Similar cases in the literature underline risk factors such as female gender, advanced age at surgery, and underlying thyroid pathology. Management included intravenous calcium correction followed by long-term oral supplementation with calcitriol and calcium, resulting in significant symptom improvement.

Conclusion: Although rare, delayed hypoparathyroidism should be considered in patients presenting with unexplained hypocalcemia and a history of thyroidectomy, regardless of the time elapsed since surgery. Prompt recognition and appropriate management can prevent severe complications and improve patient outcomes.