A 30-year-old woman with primary hyperthyroidism due to Graves-Basedow disease of 4 years duration.
After presenting a skin reaction related to the initial management with the antithyroid drug methimazole, treatment with propiltiouracil was started, and later with lithium without achieving adequate control of thyroid hormone levels.
Due to the presence of severe disease/dl surgery was decided as definitive treatment, presenting at that time the following thyroid hormone levels: TSH 0.01 μU/ml (0.35-4.94 μU/ml), FT4-1.48 ng).
Total thyroidectomy was performed.
After suspending serum therapy and 5 hours after starting oral tolerance, the patient complained of paresthesia and spasm-pedal.
Serum ionized calcium levels are requested with a result of 3.6 mg/dl. With the diagnosis of acute hypocalcemia, intravenous calcium gluconate is administered, with symptomatic improvement.
After 24 hours, an ionic calcium 4.4 mg/dl was observed, the patient discontinued intravenous administration and underwent supplementation with oral calcium and calcitriol.
The patient remained asymptomatic 48 hours after the onset of new spasm pedal.
The patient was reintroduced intravenous calcium gluconate after symptomatic treatment. Oral treatment was restarted, which was accompanied by new onset of muscle spasms. An ionized calcium of 3.6 mg was maintained.
Despite adequate intake of calcium and high doses of oral calcitriol, hypocalcemia persists 48 hours after its onset (ionic calcium: 3.2 mg/dl).
The next day, a new laboratory test was ordered, showing decreased calcium and magnesium levels, suppressed PTH and hyperphosphatemia.
hypercalcaemia, hypomagnesaemia secondary to hamstring bone syndrome due to severe hyperthyroidism, transient hypoparathyroidism secondary to hypomagnesaemia
