methimazole and Hypocalcemia

A 29-year-old pregnant woman with Graves' disease presented with severe persistent hypocalcaemia after thyroidectomy. Six months prior to presentation she was diagnosed with Graves' disease and remained uncontrolled with methimazole. She was confirmed pregnant prior to radioactive iodine ablation (RAI), and underwent total thyroidectomy during her second trimester. After surgery, continuous intravenous calcium infusion was required until delivery of the fetus allowed discontinuation at postoperative day 18, despite oral calcium and calcitriol administration. A total of 38 g of oral and 7.5 g of intravenous elemental calcium was administered. We report an unusual case of recalcitrant hypocalcaemia thought to be due to a combination of postoperative hypoparathyroidism, combined with thyrotoxic osteodystrophy and pregnancy, after surgical correction of Graves' disease. Increased vigilance and early calcium supplementation should be a priority in the management of these patients.

Topics: Administration, Oral; Adult; Antithyroid Agents; Calcium; Drug Administration Schedule; Female; Graves Disease; Humans; Hypocalcemia; Hypoparathyroidism; Infusions, Intravenous; Methimazole; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Second; Thyroidectomy; Thyrotoxicosis; Time Factors; Treatment Outcome

Chromosome 22q11.2 deletion syndrome is a multisystem genetic disorder that presents with hypocalcemia due to congenital hypoparathyroidism; cardiovascular, renal, and facial anomalies; and skeletal defects. This syndrome is also associated with an increased risk of autoimmune disease. We report here on a 33-year-old Japanese woman with 22q11.2 deletion syndrome complicated by Graves' disease. The patient had facial abnormalities and a history of a surgical procedure for a submucous cleft palate at age 3 years. At age 33, the patient was diagnosed with Graves' disease because both hyperthyroidism and thyroid stimulating hormone receptor antibody were present. The patient's serum calcium level was within the normal range, but symptomatic hypocalcemia developed 1 month after treatment with methimazole was started for thyrotoxicosis. Methimazole was discontinued because it caused liver dysfunction, so the patient underwent total thyroidectomy to treat her Graves' disease. We examined longitudinal changes in the number of subsets of CD4 and CD8 lymphocytes, including regulatory T (T reg) cells and PD-1

Topics: Adult; Antithyroid Agents; B-Lymphocytes; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; DiGeorge Syndrome; Female; Flow Cytometry; Graves Disease; Humans; Hypocalcemia; Longitudinal Studies; Methimazole; Programmed Cell Death 1 Receptor; T-Lymphocytes, Regulatory; Thyroidectomy

A 57 year old female came with the complaint of recurrent headache, often fatigue, and sometimes feel numbs and rigid in her extremities, no other symptom was noted. Her body weight is stable and she was in menopausal state. She had a history of partial thyroidectomy 20 years ago and continues thiamazole 2.5 mg with seldom regular consult to physician. From the physical examination, the patient had a scar from thyroid surgery and other organs were in the normal condition. From laboratory examination, there was slight normocytic normochromic anemia (Hb: 10.7 gr/dL), normal fT4: 1.21 ng/dL (0.7-1.48 ng/dL), slightly low Calcium: 8.3 mg/dL (8.5-10.2 mg/dL), others were within normal limit but there was no Phosphorus level data. She was currently on medication: thiamazole 2.5 mg once daily, CaCO3 500 mg once daily, and alfacalcidol 1 mcg once daily, to prevent the rigid and numbness that she felt before. For further investigation, we performed a PTH test with result of hypoparathyroidism with parathyroid hormone 7 pg/mL (15-65 pg/mL) and brain CT-scan with result there was a symmetrical bilateral calcification in radiate corona, frontal lobes, temporal lobes, basal ganglia, thalamic, and dentate nuclei of cerebelli. There was no data about the histopathology examination of the thyroid tumor because the patient did not keep the data. The mechanism of intracranial calcification in hypoparathyroidism, more often seen in pseudohypoparathyroidism than in idiopathic hypoparathyroidism, has not been completely elucidated. It may be related more to the duration of hypocalcaemia and hyperphosphataemia than parathyroid hormone itself. Hyperphosphataemia promotes ectopic calcification in brain tissue in hypoparathyroidism. Intracranial calcification is one of the features of chronic hypocalcemia, and the calcifications typically involve basal ganglia, thalami, and the cerebellum.

Topics: Brain; Calcinosis; Calcium; Female; Humans; Hypocalcemia; Hypoparathyroidism; Methimazole; Middle Aged; Thyroidectomy; Tomography, X-Ray Computed

We report a case of thyrotoxicosis with prolonged post-treatment muscle cramp and hypocalcemia. A 36 year-old woman with hyperthyroidism was treated with Methimazole (MMI). As plasma levels of T4 and T3 were normalized, hypocalcemia was noted and severe cramp of skeletal muscle appeared so that the patient was unable to walk. The cramp was gradually relieved as the levels of thyroid hormones re-increased by discontinuance of MMI, and recurred as the hormone levels were normalized by readministration of MMI. The plasma levels of free calcium ion was positively correlated with those of thyroid hormones, and the muscle cramp was worsened with lowering of the calcium level. Serum examination also revealed vitamin D-deficiency, which was probably due to an unbalanced diet of the patient. A therapeutic trial with 1 alpha-vitamin D3 and calcium lactate in addition to MMI improved both thyrotoxicosis and muscle cramp. These findings suggested that hypocalcemia due to vitamin D-deficiency was involved in the exceptionally prolonged muscle cramp associated with the treatment of hypothyroidism in this patient.

Topics: Adult; Cholecalciferol; Female; Humans; Hypocalcemia; Lactates; Lactic Acid; Methimazole; Muscle Cramp; Thyrotoxicosis; Vitamin D Deficiency

From 1959 to 1970, 272 operations for thyrotoxicosis were performed. Most of the patients received anti-thyroid drugs and thyroid hormones preoperatively. The patients were continuously followed up. The primary results with low morbidity and no mortality as well as the long term results with a low rate of recurrence and a relatively high incidence of thyroid substitution are discussed. A safe and effective programme for surgical treatment of thyrotoxicosis is described. Anti-thyroid drugs and thyroid hormones should be administered as the method of choice in preparing these patients for surgery.

Topics: Adolescent; Adult; Aged; Antithyroid Agents; Carbimazole; Child; Female; Goiter; Humans; Hyperthyroidism; Hypocalcemia; Hypothyroidism; Laryngoscopy; Length of Stay; Male; Methimazole; Middle Aged; Paralysis; Postoperative Complications; Preoperative Care; Propylthiouracil; Recurrent Laryngeal Nerve; Thyroxine; Triiodothyronine

Topics: Adolescent; Child; Female; Graves Disease; Humans; Hyperthyroidism; Hypocalcemia; Laryngeal Edema; Male; Methimazole; Methods; Postoperative Complications; Potassium Iodide; Propranolol; Propylthiouracil; Thyroid Hormones; Thyroidectomy