Abstract

MENESES, Adriana Costa; ALVES, Sílvia Castro  and  MARTINS, Diana Lima. Iatrogenic hypoparathyroidism: a challenge at several levels. Rev Port Med Geral Fam [online]. 2019, vol.35, n.4, pp.323-329. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v35i4.12067.

Introduction: The family physician (FF) is often confronted with clinical postoperative changes. The hypoparathyroidism, main complication from total thyroidectomy, presents a large clinical spectrum, being challenging during its treatment and follow-up. Case description: Seventy-year-old female, illiterate, subject to a complete thyroidectomy and right superior parathyroidectomy in March/2010. During hospital admission, she presented perioral and limbs paresthesia, a consequence of hypocalcaemia, which reverted. In the last day of internment, the calcium values were normal and in the discharge note, there is no mention of supplementation necessity. In the discharge day, the patient went to the emergency room (ER) with the reappearance of symptoms. She was supplemented with oral calcium and clinically evaluated after a week, where there was still hypocalcemia, so she continued with supplementation. In the clinical reassessment with FF (eighteen days after surgery), a discharge letter from surgical hospitalization was delivered, and no written information on observation was available in the ER. In hospital consultation, there is no register of hypoparathyroidism. In March/2011, the patient complains to her FF about sporadic paresthesia which was treated with magnesium. In 2012, after a FF change and review of clinical history, she made an analytical study where was detected hypocalcemia and reinstated supplementation for three months. About a year later, the patient has a new episode of paresthesia associated with claw hands, supplemented with calcium in the ER, with verbal instruction to keep that therapy. Three months later, the FF was informed of this occurrence, performed a clinical study and maintained supplementation, with clinical periodic evaluations. Since then, the patient has been without symptoms. Comment: An effective articulation between primary and secondary health care is essential, as well as periodic medication revision (especially in cases of illiteracy), in addition to adequate clinical evaluation. The follow-up of this entity is complex, implying correction of the factors that influence calcium levels, under penalty of an ineffective treatment.

Keywords : Hypoparathyroidism; Iatrogenic disease; Primary health care.

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