Endocrine Abstracts

JOINT3979

Introduction: Iatrogenic hypoparathyroidism is a well-documented complication of total thyroidectomy, often manifesting as hypocalcemia-related neuromuscular symptoms. However, atypical dermatologic presentations, such as amicrobial pustulosis, remain poorly recognized. This case highlights the importance of suspecting hypoparathyroidism in patients presenting with unusual post-surgical dermatologic manifestations [1,2].

Case Presentation: A 52-year-old female underwent total thyroidectomy in November 2021 for a multinodular goiter. She had no immediate postoperative complications and was not placed on calcium or vitamin D supplementation. In August 2022, she developed widespread pustular skin lesions consistent with amicrobial pustulosis. During her dermatologic evaluation, severe hypocalcemia (34 mg/l) was incidentally discovered, prompting an endocrine assessment that confirmed iatrogenic hypoparathyroidism. Treatment with intravenous calcium and vitamin D supplementation led to the resolution of both her cutaneous and biochemical abnormalities within one month. However, four months after discontinuation of vitamin D due to supply issues, she presented again with similar pustular lesions associated with severe hypocalcemia, reaffirming the link between her skin manifestations and calcium metabolism disorder.

Discussion and Conclusions: This case illustrates an unusual presentation of iatrogenic hypoparathyroidism, where amicrobial pustulosis was the initial and predominant manifestation. The pathophysiological link between hypocalcemia and pustular dermatoses remains unclear, but calcium plays a critical role in keratinocyte differentiation and immune response regulation. Hypocalcemia-induced alterations in epidermal homeostasis may predispose to inflammatory skin conditions, such as pustulosis [3,4]. A major challenge in this case was the delayed diagnosis of hypoparathyroidism, as the patient had no classic neuromuscular symptoms like tetany or paresthesia. Instead, the recurrent pustular lesions were the primary indicator of underlying metabolic imbalance. This underscores the need for clinicians to consider calcium and parathyroid hormone (PTH) levels in cases of unexplained pustular eruptions, particularly in post-thyroidectomy patients [5]. In conclusion, this case emphasizes the necessity of maintaining a high index of suspicion for hypoparathyroidism in post-thyroidectomy patients with atypical dermatologic presentations.

References: 1. "Postoperative hypoparathyroidism: a review." The Laryngoscope, 2010;120(3):500-508. 2. "Postoperative Hypoparathyroidism—Risk of Fractures, Psychiatric Diseases, Cancer, Cataract, and Infections." The Journal of Clinical Endocrinology & Metabolism. 3. "The skin: an indispensable barrier." Experimental Dermatology, 2008;17(12):1063-1072. 4. "Targeted inactivation of the 25-hydroxyvitamin D3–1α-hydroxylase gene in mice causes growth retardation, rickets, and a severe disturbance of calcium metabolism." The Journal of Biological Chemistry. 5."Calcium and the skin: new insights into cutaneous biology and skin disease." Dermatology Online Journal.