Hypocalcemia After Thyroidectomy and Parathyroidectomy in a Pregnant Woman

Abstract

Hypoparathyroidism during pregnancy is a very rare endocrine disorder. The majority of cases are postsurgical (75%). Managing pregnant or nursing women with hypoparathyroidism is challenging due to complications arising from either under- or overtreatment, including premature delivery or fetal death, abortion, stillbirth, perinatal death, and neonatal tetany. Specific adaptations are needed within each time period to meet the fetal, neonatal, and maternal calcium requirements. A systematic search was performed on PubMed using the search terms "pregnancy" and "hypoparathyroidism." Included were articles published in English between January 1, 1966, and January 1, 2018. We provide an overview of all published cases (n = 43) of hypoparathyroidism in pregnancy, including a case report of a 29-year-old pregnant woman who underwent a total thyroidectomy before her current pregnancy because of a therapy-resistantant Graves' disease. The procedure was complicated by postsurgical hypoparathyroidism. She carried out the pregnancy to term with minor complaints of paresthesia and muscle cramps. Furthermore, we discuss treatment, complications, and follow-up of hypoparathyroidism in pregnancy. Treatment of hypoparathyroidism in pregnancy should still be individualized, depending on the patient's complaints and serum levels of calcium, which should be maintained in the lower normal range of 2.15 to 2.55 mmol/l, according to the literature. We recommend monitoring calcium levels every 3 to 4 weeks throughout the pregnancy, within 1 week postpartum, and monthly during lactation to ensure normocalcemia.

Keywords: calcium; hypoparathyroidism; parathyroidectomy; pregnancy; thyroidectomy; vitamin D.