A 37-year-old woman from Puerto Aisén, with a history of thyroidectomy performed at 18 years of age due to a diffuse hyperthyroid goiter.
As a result of surgery, the patient developed definitive hypoparathyroidism.
Calcium and vitamin D supplementation was indicated, treatment that the patient fulfilled very irregularly and without laboratory controls.
Fifteen years later, in 1999, she consulted our hospital for cramps, paresthesias and facial spasms, in addition to manifest Chvostek and Trousseau signs.
Calcium and vitamin D treatment was restarted and calcium, T4 and TSH tests were requested.
The patient did not return to control.
It reappeared in November 2003, without treatment.
He had a marked impairment of general condition, asthenia, muscle weakness, cramps, paresthesias and headache.
Her menstruations were abundant.
On physical examination, hypothyroid facies, thyroidectomy scar, regular pulse 70x', blood pressure 110/70 and abdominal pain were normal, and signs of Chvostek and Trousseau were normal;
Her tests revealed calcemia 7.98 mg/dL (probable laboratory error, due to discordance with subsequent calcemia g and hemoglobin 6.4dL, hemoglobin 6.7 mg/dL, BUN 146.6 mg/dL, total albumin 9.4).
With a diagnosis of post-thyroidectomy hypoparathyroidism and hypothyroidism and iron deficiency anemia, treatment with Elcal D Forte® (calcium carbonate 1.125 mg + vitamin D 175 IU) 1, Elcal® (calcium carbonate 800 mg)
Two weeks later, the patient developed dyspnea on minimal exertion, epigastric pain, nausea and rapidly progressive edema.
Physical examination revealed regular auscultation with fever, heart rate 70x', blood pressure 100/70 mmHg, orthopnea, generalized edema, jugular engorgement, pulmonary rales, heart sounds a
There were no signs of deep venous thrombosis.
She was hospitalized.
His admission exams showed: chest X-ray: cardiomegaly and pulmonary congestion.
ECG: sinus rhythm, 83x', generalized low voltage, prolonged QT interval and nonspecific changes in ventricular repolarization.
Echocardiogram: marked dilatation, systolic dysfunction and restrictive diastolic dysfunction of the left ventricle, severe mitral and tricuspid regurgitation, moderate systolic pulmonary hypertension, moderate pericardial effusion and dilatation of the left atrium.
Abdominal ultrasound: congestive hepatomegaly.
Upper gastrointestinal endoscopy: hyperemic gastritis.
Calcemia 2.9 mg/dL, parathyroid hormone 5.9 ng/l (vn: 10-73), magnesium 1.08 mEq/l (vn: 1.4-2.1), albumin 3.3 g/dL, sodium
1.
A diagnosis of congestive heart failure secondary to severe hypocalcemia, diagnosed by substitution with thyroid hormone and aggravated by iron deficiency anemia was proposed.
The patient was treated with calcium gluconate 1 g iv c/12 h, calcium carbonate 2 g vo, vitamin D 175 μ/day, vitamin D 300,000 IU once, l-thyroxine 12.5 mg digoxin, iron sulfate capry.
The patient had a favorable diuresis and improvement in the manifestations of heart failure, edema disappearance and hepatomegaly.
Ten days later he had calcemia of 6 mg/dL, hematocrit of 37% and control echocardiogram showed reduction of the degree of mitral and tricuspid reflux, decrease of the systolic pressure of the pulmonary artery from 50 to 33 mmHg.
In subsequent controls, up to 18 months, the patient strictly adhered to the treatment, only presented dyspnea at medium to major efforts, his calcemia was maintained between 8 and 8.5 mg/dL normalization left ventricular filling phase, with marked left ventricular dysfunction
