Delayed Post-Surgical Hypoparathyroidism: The Forgotten Chameleon!

[helvella]

That there could be such a long delay in hypocalcaemia occurring is news to me. I knew of days, maybe weeks, but fifteen years? No - I had no idea.

Let this be a useful piece of information for all who have had thyroid surgery. Hopefully not needed, but here if it is.

J Clin Diagn Res. 2017 Feb;11(2):OD07-OD09. doi: 10.7860/JCDR/2017/23609.9260. Epub 2017 Feb 1.

Delayed Post-Surgical Hypoparathyroidism: The Forgotten Chameleon!

Kamath SD1, Rao BS2.

Author information

1 Consultant, Department of Medicine, Tata Main Hospital , Jamshedpur, Jharkhand, India .

2 Senior Specialist and Head of Department, Department of Medicine, Tata Main Hospital , Jamshedpur, Jharkhand, India .

Abstract

Delayed hypoparathyroidism, due to accidental gland removal or ischemia of parathyroids can present many years after thyroidectomy and symptoms may be non-specific. This condition, if not diagnosed timely, may prove fatal and have serious consequences. Hence, clinicians must have a high index of suspicion to treat this condition. All patients with a history of previous thyroid surgery, who come with vague symptoms like fatigue, muscle aches should undergo estimation of serum calcium, phosphorus and Parathyroid Hormone (PTH) due to the lack of any pathognomonic features of hypoparathyroidism. We report a rare case of delayed post-surgical hypoparathyroidism who became symptomatic 15 years after thyroid surgery and remained so for another 10 years before the final diagnosis was established.

KEYWORDS:

Hypocalcaemia; Late; Parathyroid glands; Surgery; Tetany

PMID: 28384917

PMCID: PMC5376817

DOI: 10.7860/JCDR/2017/23609.9260

ncbi.nlm.nih.gov/pubmed/283...

(Can't help wondering about the phrasing: may prove fatal and have serious consequences.)

[SilverAvocado]

Yes that phrase is interesting. I had thought you'd die within days or maybe weeks if this went untreated, and I'd think lots of clinicians would believe the same.

Good informatio, though. I never bother to think about my parathyroids now that they've seemed fine.

[Clutter]

Helvella,

If it took 25 years to make a diagnosis I wonder how many more years undiagnosed for it prove fatal and have serious consequences?

[helvella Administrator Thyroid UK in reply to Clutter]

Clutter,

In this case, yes, it is an extraordinarily long time and might never have proved fatal.

The point appears to be that you can never rule parathyroid problems out if you have ever had thyroid surgery. I doubt many doctors would be looking even months later, let alone years, and almost certainly not after many years. Looks as if the doctors of this patient didn't think of it for the ten years between things going wrong and diagnosis - wonder how many hands they passed through?