CASE REPORT : FAHR'S SYNDROME ON POST THYROIDECTOMY PATIENT

Abstract

Background: Fahr’s syndrome is slowly progressive, a neurodegenerative disorder, characterized by bilateral symmetrical calcium deposits of ganglia basalis. Fahr’s syndrome is the secondary form of brain calcification that is caused by various metabolic, infectious or degenerative disease. The most common metabolic disorders that cause Fahr’s syndrome is hypoparathyroidism, which is characterized by phosphate and calcium abnormalities. Case Illustration: a 65-year-old female patient who presented with the transient loss of consciousness, It suddenly happened, while she was sitting. The patient tends to be quiet and had no response when she was called. This complaint lasts for 1 minute. Previously, this complaint had happened 30 years ago. The patient had undergone a thyroidectomy 35 years ago. She started having a seizure which progressed 5 years after surgery. In the emergency department, the patient was good oriented and full of consciousness. The neurology examination reveals no abnormal findings. The patient had no motor or sensory symptoms. Serum calcium level was low (4,1 mg/dL) and PTH levels was extremely low (5,53pg/ml). Computed tomography scan of the brain showed intracranial calcification in the basal ganglia, suggestive for Fahr’s syndrome. Discussion: Hypoparathyroidism is a complication that is often found in thyroidectomy. It can lead to increased calcinosis, and it believed that calcium deposition begins in the vessel wall, eventually extending to the neuron. Conclusion: Chronic hypocalcemia due to postoperative hypoparathyroidism can remain subclinical for a long time. Timely recognition of idiopathic and iatrogenic hypoparathyroidism allows appropriate treatment that can prevent the development and clinical manifestations of Fahr’s syndrome and potentially slow its progression.