Case history
Case history #1
A 45-year-old woman has a total thyroidectomy for papillary carcinoma. Ten hours after the operation she complains of perioral and digital paresthesias. Her condition rapidly deteriorates with a sense of constriction in her throat and difficulty on inspiration.
Case history #2
A 52-year-old woman is operated on for longstanding primary hyperparathyroidism diagnosed by serum calcium of 12.6 mg/dL (3.15 mmol/L) and parathyroid hormone (PTH) of 270 picograms/mL. Her intraoperative PTH after resection of a 2-gram adenoma was 12 picograms/mL. Twelve hours after her procedure, she complains of paresthesias and anxiety. Her serum calcium is 6.8 mg/dL (1.7 mmol/L).
Other presentations
Hypoparathyroidism presents with hypocalcemia. Surgical hypoparathyroidism can present as long as a week after the operation. In some cases, years may elapse from the time of surgery to the presentation and diagnosis. A relatively sudden drop in blood calcium will manifest as muscle twitches or spasm, including the possibility of life-threatening laryngeal spasms; muscle cramps; intermittent digital and/or perioral paresthesias; irregular heart beat; confusion; disorientation; or convulsions. Slow-onset hypocalcemia may present with muscle cramps, irregular heart beat, confusion or disorientation, brittle nails, dry hair, and cataracts. Nonsurgical etiologies of hypoparathyroidism tend to present more gradually with hypocalcemia, and some cases may be detected on laboratory findings prior to symptoms. Infants may present with hypocalcemia and transient hypoparathyroidism due to prematurity (their parathyroid glands have not fully developed by the time of birth) or suppression of their parathyroid function due to maternal hypercalcemia, either recognized or unrecognized before delivery. Many of the genetic disorders can present at birth or in infancy or early childhood. Occasionally, genetic disorders are diagnosed in adulthood due to the mild nature of the defect.
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