CASE REPORT
Persistent Hypocalcemia after Thyroidectomy Stabilized with Magnesium
 
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1
Faculty of Medicine, Autonomous University of the State of Mexico (UAEMéx), MEXICO
 
2
“Mónica Pretelini Sáenz” Maternal-Perinatal Hospital and Ciprés Grupo Médico (CGM), MEXICO
 
 
Online publication date: 2020-04-05
 
 
Publication date: 2020-04-05
 
 
Electron J Gen Med 2020;17(5):em220
 
KEYWORDS
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.
 
REFERENCES (21)
1.
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....
 
2.
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... PMID:26578317.
 
3.
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... PMID:28545530.
 
4.
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.23... PMID: 25491348.
 
5.
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/JCI107... PMID:4750437.
 
6.
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.4... PMID:21812031.
 
7.
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/JCI109... PMID:227929.
 
8.
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....
 
9.
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-3... PMID:4360918.
 
10.
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.2... PMID:28857066.
 
11.
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/intern... PMID: 1392187.
 
12.
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-7... PMID:1939521.
 
13.
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/pd....
 
14.
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.3... PMID:29637622.
 
15.
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....
 
16.
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....
 
17.
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.328... PMID:25938945.
 
18.
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... PMID:31619668.
 
19.
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/chiru... PMID:31670636.
 
20.
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.S... PMID:31564973.
 
21.
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... PMID:25448646.
 
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