A Case of Hypercalcemia after Thyroidectomy

Abstract

Abstract Total thyroidectomy is complicated by hypoparathyroidism in 1-3% of patients. Hypoparathyroidism is treated with oral calcium and vitamin-D supplements. Everyday use of calcium and vitamin D can lead sometimes to hypercalcemia. Ingestion of large amounts of calcium and absorbable alkali that cause hypercalcemia, various degrees of renal failure, and metabolic alkalosis, can be associated with a diagnosis of calcium-alkali syndrome. This syndrome was first identified as milkalkali syndrome, after treatment of peptic ulcer disease with milk and alkali which was widely adopted at the beginning of the 20th century. With the introduction of histamine-2 blockers and proton pump inhibitors, the occurrence of milk-alkali syndrome became rare; however, it has emerged recently as calcium-alkali syndrome because of the wide availability and increasing use of calcium carbonate, mostly for osteoporosis prevention. We present a female patient with hypoparathyroidism who presented with hypercalcemia and alkalosis as a result of treatment with calcium carbonate, vitamin D and thiazide diuretic. The patient was treated successfully by discontinuation of the above drugs, intravenous fluid administration and enhancement of calcium renal excretion. Hypercalcemia presenting as calcium-alkali syndrome is a diagnosis that requires a high index of suspicion in order to quickly identify the disorder and initiate appropriate therapy. It is important for clinicians to keep the syndrome on their list of differential diagnosis.