Delayed Onset Hypoparathyroidism Following Thyroidectomy: Case Report and Review of Literature

Abstract

Delayed postsurgical hypoparathyroidism (hypoPT) is a rare but important complication of thyroidectomy, often presenting years after the initial procedure. We report the case of a 48-year-old woman with a remote history of total thyroidectomy for Graves' disease, who presented with neuromuscular symptoms and severe hypocalcemia 22 years after surgery. Laboratory investigations revealed low calcium, low parathyroid hormone (PTH), and elevated phosphate, consistent with hypoPT. The patient was initially managed with intravenous calcium followed by alfacalcidol therapy. Literature review highlights that most cases of delayed hypoPT occur in women following total thyroidectomy and vitamin D deficiency. Mechanisms may involve progressive parathyroid hypovascularisation and scar retraction. Current guidelines do not recommend routine long-term calcium monitoring post thyroidectomy, but this case underscores the need for vigilance and patient education regarding hypocalcemia symptoms. Lifelong follow-up may be warranted for high-risk individuals.