A 51-year-old gentleman underwent a thyroidectomy 7 years ago for a benign multinodular goitre. Unfortunately, as a consequence of the surgery he became hypocalcaemic secondary to hypoparathyroidism. He was commenced on calcichew 1 tablet daily, calcium carbonate ‘500’ twice daily, vitamin D injections and 1- alphacalcidol 1 mcg daily. Initially, his PTH remained detectable and therefore it was hoped there would be some recovery, but over time this was proven not to be the case.
It was difficult to control his calcium within the normal range and our aim was to keep his calcium borderline low, to kick start any remaining parathyroid activity. Blood results at the time were as follows, calcium 2.11 mmol/l, phosphate 1.18 mmol/l, PTH 2.0 pmol/l. On reduction of the 1 alpha calcidol, he became symptomatic with carpo-pedal spasm, tetany and parasthesia. High doses of calcium were then needed to prevent these symptoms which in turn caused symptomatic constipation and a subsequent anal fissure requiring EUA and sphincterotomy. He developed depression and lethargy which can result as a consequence of abnormal calcium handling. He eventually filed a claim for malpractice, as he felt the thyroidectomy was an operation he should never have had, and the consequences of its side effects have had a severe impact on his quality of life.
After struggling with this problem for many years, we eventually got funding to start tereparatide, daily subcutaneous PTH injections at the end of July this year. Since then he has come off all his calcium and 1 alpha calcidol and is maintained on the PTH alone, current calcium 2.35 mmol/l, phosphate 1.15 mmol/l and PTH 1.2 pmol/l.