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 paraesthesias. 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 long-standing primary hyperparathyroidism diagnosed by total serum calcium of 3.15 mmol/L (12.6 mg/dL) and parathyroid hormone (PTH) of 270 nanograms/L (270 picograms/mL). Her intraoperative PTH after resection of a 2-gram adenoma was 12 nanograms/L (12 picograms/mL). Twelve hours after her procedure, she complains of paraesthesias and anxiety. Her total serum calcium is 1.7 mmol/L (6.8 mg/dL).
Other presentations
Hypoparathyroidism presents with hypocalcaemia. 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 paraesthesias; irregular heart beat; confusion; disorientation; or convulsions. Slow-onset hypocalcaemia may present with muscle cramps, irregular heart beat, confusion or disorientation, brittle nails, dry hair, and cataracts. Non-surgical aetiologies of hypoparathyroidism tend to present more gradually with hypocalcaemia, and some cases may be detected on laboratory findings prior to symptoms. Infants may present with hypocalcaemia 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 hypercalcaemia, either recognised or unrecognised 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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