Hypoparathyroidism — ESENeph MCQ

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EasyElectrolyte DisordersHypoparathyroidismESENeph

A 30-year-old man has a serum calcium of 1.6 mmol/L, phosphate 2.8 mmol/L, PTH 0.8 pmol/L (low), and magnesium 0.4 mmol/L. He recently had thyroid surgery. What is the most likely diagnosis?

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Correct answer: B — Post-surgical hypoparathyroidism

Low calcium, high phosphate, and low PTH after thyroid surgery is classic for post-surgical hypoparathyroidism from inadvertent parathyroid gland damage or removal. The low magnesium may also contribute to impaired PTH secretion. Treatment is with calcium and active vitamin D (Alfacalcidol/Calcitriol), as native vitamin D cannot be activated without adequate PTH. In pseudohypoparathyroidism, PTH would be high. Hungry bone syndrome shows low calcium but also low phosphate.

Reference: NICE NG132 2019 – Hyperparathyroidism; Endocrine Society 2022