Authors
V K Balachandrana, Malavika Ba
a. Cardio-Diabetology, Bharani, 34, People’s Nagar, Kollam, Kerala.
Abstract
Background: Intracerebral calcifications can be associated with various conditions, including hypoparathyroidism. This case highlights a rare presentation of post-surgical hypoparathyroidism.
Case Presentation: A 60-year-old female presented with recurrent tonic-clonic seizures and carpopedal spasms. She had a history of total thyroidectomy 15 years prior, with inadequate thyroid hormone replacement.
Investigations: Blood tests revealed severe hypocalcemia (6.4 mg/dl), hyperphosphatemia (7.1 mg/dl), and very low parathyroid hormone (3.6 pg/dl), consistent with hypoparathyroidism and secondary hypothyroidism. A CT scan of the brain demonstrated extensive calcifications involving the corpus striatum, basal ganglia, putamen, thalamus, cerebellum, and cortex. EEG was abnormal, and ECG showed QTC prolongation.
Management & Outcome: The patient was diagnosed with hypothyroidism, hypoparathyroidism, extensive brain calcifications, and uncontrolled seizures. Management included sodium valproate for seizures, high-dose calcitriol, and calcium supplementation. The report stresses the importance of routine calcium estimation in seizure disorders, especially given that some anticonvulsants (like DPH) can worsen hypocalcemia and mask symptoms.
Conclusion: This case underscores that primary hypoparathyroidism following total thyroidectomy can lead to extensive intracerebral calcifications and intractable seizures. Early recognition through calcium estimation is crucial for appropriate management.