Vitamin D in patients with hypoparathyroidism/hypocalcemia

Abstract

A 36-year-old female was seen in consultation at the endocrinology clinic for postsurgical hypoparathyroidism after she underwent a total thyroidectomy, 5 years ago, due to compressive symptoms from a nontoxic multi-nodular goiter. The patient has had since then considerable issues with symptomatic hypocalcemia, requiring multiple hospitalizations and emergency department visits. She cannot tolerate serum calcium levels less than 9 mg/dL (normal range, 8.9–10.3 mg/dL). Her symptoms included severe peripheral paresthesia, laryngospasm, severe dyspnea, severe tetany, and sometimes altered mental status. She also had a cardiac event due to severely symptomatic hypocalcemia. The management has been challenging given recurrent hyperphosphatemia (due to treatment with calcitriol), with calcium and phosphorus product reaching 120, with persistent symptomatic hypocalcemia.