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What investigations are needed in this case?

belongs to book: CLINICAL CASES IN ENDOCRINOLOGY|Pramila Kalra|| Chapter number:15| Question number:2.1

waelhammad

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2022-11-19

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A 41-year-old female with a history of Graves’ disease is admitted to our hospital for further evaluation and treatment of hypocalcemia. She gives a history of receiving radioactive iodine supplementation for the treatment of her Graves’ disease about 6 years back, when she received dose of 10 millicurie and after 3 months of the ablation patient became hypothyroid and was started on levothyroxine supplementation in a dose of 125 mg per day and henceforth she has been maintaining a normal calcium level. She has no family history of bone and mineral metabolism disorders. She was diagnosed as severe hypocalcemia 1 week back (serum corrected calcium level, 6.7 mg/dL) and referred to our hospital. On admission, her blood pressure is 100/76 mm Hg, and her pulse rate is 68 beats/minute with regular rhythm. Her thyroid gland is barely palpable. Her heart and breathing sounds are clear. Trousseau and Chvostek signs are positive. Chest X-ray is normal. Electrocardiogram shows a prolonged QTc interval (0.49 msec).

What investigations are needed in this case?

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waelhammad

2022-11-19

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The blood chemistry shows low serum corrected calcium level (6.3mg/dL) and fasting serum phosphate level is 6.5mg/dL (range 2.5 mg/dL to 4.5 mg/dL), normal magnesium level (2.4mg/dL), and normal alkaline phosphatase level (160U/L). There is no renal and liver dysfunction. Endocrine examinations shows that serum 25(OH)D level is markedly decreased (<5ng/mL), and intact PTH (iPTH) and 1,25(OH)2D levels are low (5pg/mL and 23pg/mL). Thyroid function is in normal range (See Flowchart 15.1).

Lab tests-initial

• Serum calcium

• Serum phosphorus

• Serum magnesium

• Serum albumin

• Serum alkaline phosphatase

• 25 (OH) D

• 1,25(OH)2D

• Intact PTH

• Serum creatinine

The blood chemistry shows low serum corrected calcium level (6.3mg/dL) and fasting serum phosphate level is 6.5mg/dL (normal range 2.5–4.5 mg/dL),normal magnesium level (2.4mg/dL), and normal alkaline phosphatase level (160U/L). There is no evidence of renal and liver dysfunction. Endocrine examinations shows that serum 25(OH)D level are markedly decreased (<5ng/mL), and intact PTH (iPTH) and 1,25(OH)2D levels are low (5pg/mL and 23pg/mL). Thyroid function is in normal range.

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