Persistent Hypocalcemia after Thyroidectomy Stabilized with Magnesium

Alvaro Contreras Salazar; Jesús Armando Del Moral Bastida; Hugo Mendieta Zerón

doi:10.29333/ejgm/7883

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Alvaro Contreras Salazar ¹ ^* , Jesús Armando Del Moral Bastida ², Hugo Mendieta Zerón ¹ ²

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¹ Faculty of Medicine, Autonomous University of the State of Mexico (UAEMéx), MEXICO² “Mónica Pretelini Sáenz” Maternal-Perinatal Hospital and Ciprés Grupo Médico (CGM), MEXICO^* Corresponding Author

Abstract

We present the case of a 53-year-old woman who underwent total thyroidectomy as a multinodular goiter treatment, which after surgery presented hypocalcemia that did not reverse with combined therapy of calciotropic hormones and calcium supplementation. The symptomatology remission was reached only after the prescription of magnesium lactate tablets. It is known that hypocalcemia is the main complication of this surgery, however, little is known about hypomagnesemia and its role as a cause and consequence of the imbalance in calcium homeostasis in this kind of patients. The clinical and biochemical evolution of the patient is evaluated, as well as the pathophysiology of hypocalcemia due to magnesium deficiency that involves a large number of processes such as renal, intestinal and bone function.

Keywords

hypocalcemia
hypomagnesemia
thyroidectomy

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Case Report

ELECTRON J GEN MED, 2020, Volume 17, Issue 5, Article No: em220

https://doi.org/10.29333/ejgm/7883

Publication date: 05 Apr 2020

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Declaration of Conflict of Interest: No conflict of interest is declared by author(s).

References

Shifrin A. Chapter 6 - Brief Overview of Calcium, Vitamin D, Parathyroid Hormone Metabolism, and Calcium-Sensing Receptor Function. In: Shifrin AL, editor. Advances in Treatment and Management in Surgical Endocrinology. Elsevier; 2020:63-70. Available at: https://www.elsevier.com/books/advances-in-treatment-and-management-in-surgical-endocrinology/shifrin/978-0-323-66195-9
Cherian AJ, Gowri M, Ramakant P, Paul TV, Abraham DT, Paul MJ. The Role of Magnesium in Post-thyroidectomy Hypocalcemia. World J Surg. 2016;40(4):881-8. https://doi.org/10.1007/s00268-015-3347-3 PMID:26578317
Luo H, Yang H, Zhao W, Wei T, Su A, Wang B, et al. Hypomagnesemia predicts postoperative biochemical hypocalcemia after thyroidectomy. BMC Surg. 2017;17(1):62. https://doi.org/10.1186/s12893-017-0258-2 PMID:28545530
Garrahy A, Murphy MS, Sheahan P. Impact of postoperative magnesium levels on early hypocalcemia and permanent hypoparathyroidism after thyroidectomy. Head Neck. 2016;38(4):613-9. https://doi.org/10.1002/hed.23937 PMID: 25491348
Reddy CR, Coburn JW, Hartenbower DL, Friedler RM, Brickman AS, Massry SG, et al. Studies on Mechanisms of Hypocalcemia of Magnesium Depletion. J Clin Invest. 1973;52(12):3000-10. https://doi.org/10.1172/JCI107498 PMID:4750437
Bilezikian J, Khan A, Potts J, Brandi M, Clarke B, Shoback D, et al. Hypoparathyroidism in the Adult: Epidemiology, Diagnosis, Pathophysiology, Target Organ Involvement, Treatment, and Challenges for Future Research. J Bone Miner Res. 2011;26(10):2317-37. https://doi.org/10.1002/jbmr.483 PMID:21812031
Freitag JJ, Martin KJ, Conrades MB, Bellorin-Font E, Teitelbaum S, Klahr S, Slatopolsky E. Evidence for Skeletal Resistance to Parathyroid Hormone in Magnesium Deficiency. J Clin Invest. 1979;64(5):1238-44. https://doi.org/10.1172/JCI109578 PMID:227929.
Naveh-Many T, Silver J, Kronenberg HM. Chapter 24 - Parathyroid hormone molecular biology. In: Bilezikian JP, Martin TJ, Clemens TL, Rosen CJ, Editor(s). Principles of Bone Biology (Fourth Edition) Academic Press, 2020:575-94. Available at: https://www.elsevier.com/books/principles-of-bone-biology/bilezikian/978-0-12-373884-4
Chase LR, Slatopolsky E, Krinski T. Secretion and Metabolic Efficacy of Parathyroid Hormone in Patients with Severe Hypomagnesemia. J Clin Endocrinol Metab. 1974;38(3):363-71. https://doi.org/10.1210/jcem-38-3-363 PMID:4360918.
Mannstadt M, Bilezikian JP, Thakker RV, Hannan FM, Clarke BL, Rejnmark L, et al. Hypoparathyroidism. Nat Rev Dis Primer. 2017;3(1):1-21. https://doi.org/10.1038/nrdp.2017.55 PMID:28857066
Mori S, Harada S, Okazaki R, Inoue D, Matsumoto T, Ogata E. Hypomagnesemia with increased metabolism of parathyroid hormone and reduced responsiveness to calcitropic hormones. Intern Med. 1992;31(6):820-4. https://doi.org/10.2169/internalmedicine.31.820 PMID: 1392187
Fatemi S, Ryzen E, Flores J, Endres DB, Rude RK. Effect of experimental human magnesium depletion on parathyroid hormone secretion and 1,25-dihydroxyvitamin D metabolism. J Clin Endocrinol Metab. 1991;73(5):1067-72. https://doi.org/10.1210/jcem-73-5-1067 PMID:1939521
Cantillano Rodríguez SN, Casasola Vargas JC, Rivera Zetina DJ. Hipomagnesemia asociada con inhibidores de bomba de protones. Med Int Méx. 2013;29(1):62-6. Available at: https://www.medigraphic.com/pdfs/medintmex/mim-2013/mim131k.pdf
Bégin M-J, Ste‐Marie L-G, Coupal L, Ethier J, Räkel A. Hypomagnesemia During Teriparatide Treatment in Osteoporosis: Incidence and Determinants. J Bone Miner Res. 2018;33(8):1444-9. https://doi.org/10.1002/jbmr.3438 PMID:29637622
Kitaigrodsky AV, Diehl M, Galich AM, Lovazzano S, Santangelo L, Giunta D, et al. Tratamiento prolongado con teriparatida en el hipoparatiroidismo grave de difícil manejo. Actual. Osteol 2015;11(2):114-24. Available at: http://osteologia.org.ar/files/pdf/rid42_2.pdf
Ambrogini E, Jilka RL. Chapter 32 - Cellular actions of parathyroid hormone on bone. In: Bilezikian JP, Martin TJ, Clemens TL, Rosen CJ, Editor(s). Principles of Bone Biology (Fourth Edition) Academic Press, 2020, p. 775-88. Available at: https://www.elsevier.com/books/principles-of-bone-biology/bilezikian/978-0-12-373884-4
Legati A, Giovannini D, Nicolas G, López-Sánchez U, Quintáns B, Oliveira JRM, et al. Mutations in XPR1 cause primary familial brain calcification associated with altered phosphate export. Nat Genet. 2015;47(6):579-81. https://doi.org/10.1038/ng.3289 PMID:25938945
Centeno PP, Herberger A, Mun H-C, Tu C, Nemeth EF, Chang W, et al. Phosphate acts directly on the calcium-sensing receptor to stimulate parathyroid hormone secretion. Nat Commun. 2019;10(1):1-12. https://doi.org/10.1038/s41467-019-12399-9 PMID:31619668
Martin S, Parfeni O, Mustata T, Andrei M, Sirbu A, Barbu C, et al. Postoperative Hypoparathyroidism in Patients After Total Thyroidectomy - Experience of a Tertiary Center in Romania. Chirurgia (Bucur). 2019;114(5):602. https://doi.org/10.21614/chirurgia.114.5.602 PMID:31670636.
Wang W, Meng C, Ouyang Q, Xie J, Li X. Magnesemia: an independent risk factor of hypocalcemia after thyroidectomy. Cancer Manag Res. 2019;11:8135-44. https://doi.org/10.2147/CMAR.S218179 PMID:31564973
Wei T, Li Z, Jin J, Chen R, Gong Y, Du Z, et al. Autotransplantation of Inferior Parathyroid glands during central neck dissection for papillary thyroid carcinoma: A retrospective cohort study. Int J Surg. 2014;12(12):1286-90. https://doi.org/10.1016/j.ijsu.2014.11.001 PMID:25448646

How to cite this article

Vancouver

Contreras Salazar A, Del Moral Bastida JA, Mendieta Zerón H. Persistent Hypocalcemia after Thyroidectomy Stabilized with Magnesium. ELECTRON J GEN MED. 2020;17(5):em220. https://doi.org/10.29333/ejgm/7883

APA

Contreras Salazar, A., Del Moral Bastida, J. A., & Mendieta Zerón, H. (2020). Persistent Hypocalcemia after Thyroidectomy Stabilized with Magnesium. Electronic Journal of General Medicine, 17(5), em220. https://doi.org/10.29333/ejgm/7883

AMA

Contreras Salazar A, Del Moral Bastida JA, Mendieta Zerón H. Persistent Hypocalcemia after Thyroidectomy Stabilized with Magnesium. ELECTRON J GEN MED. 2020;17(5), em220. https://doi.org/10.29333/ejgm/7883

Chicago

Contreras Salazar, Alvaro, Jesús Armando Del Moral Bastida, and Hugo Mendieta Zerón. "Persistent Hypocalcemia after Thyroidectomy Stabilized with Magnesium". Electronic Journal of General Medicine 2020 17 no. 5 (2020): em220. https://doi.org/10.29333/ejgm/7883

Harvard

Contreras Salazar, A., Del Moral Bastida, J. A., and Mendieta Zerón, H. (2020). Persistent Hypocalcemia after Thyroidectomy Stabilized with Magnesium. Electronic Journal of General Medicine, 17(5), em220. https://doi.org/10.29333/ejgm/7883

MLA

Contreras Salazar, Alvaro et al. "Persistent Hypocalcemia after Thyroidectomy Stabilized with Magnesium". Electronic Journal of General Medicine, vol. 17, no. 5, 2020, em220. https://doi.org/10.29333/ejgm/7883