The Hidden Hazard After Total Parathyroidectomy: A Case Report
https://doi.org/10.15605/jafes.041.S1
- Author:
Jie En Tan
1
;
Chin Voon Tong
1
Author Information
1. Institut Endokrin, Hospital Putrajaya
- Publication Type:Journal Article
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):105-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Palpation thyroiditis is an underrecognized condition
that occurs after parathyroidectomy. Symptoms range
from mild to overt thyrotoxicosis that may result in lifethreatening cardiac arrhythmias and acute coronary
syndrome. Diagnosis is made by having suppressed
thyroid-stimulating hormone (TSH) and elevated free
thyroxine 4 (fT4) or free thyroxine 3 (fT3) and low
radionuclide uptake on thyroid scan.
Case:We report a case of a 72-year-old female with underlying
end-stage renal disease on regular hemodialysis who
underwent total parathyroidectomy for tertiary hyperparathyroidism. Her thyroid function test (TFT) preoperatively was normal, and cardiac assessment showed
normal echocardiogram findings and sinus rhythm on
electrocardiogram. Her operation was uncomplicated,
involving neck exploration and all 4-gland removal.
Postoperatively, she had new-onset atrial fibrillation
(AF) with rapid ventricular response at day 5, requiring
electrical and chemical cardioversion. She had recurrent
tachyarrhythmias on day 6. Her repeated TFT showed
suppressed TSH, 0.036 mIU/L (NR 0.38–5.33) and raised
fT4, 35.4 pmol/L (NR 7.9–14.4), fT3–fT4 ratio 0.26 (<0.3),
consistent with thyrotoxicosis. She was treated as thyroid
storm (Burch-Wartofsky Point Scale 45), after ruling
out other causes. She was started on glucocorticoids,
propylthiouracil, and Lugol’s iodine. Despite biochemical
improvement, she continued to develop recurrent AF
up till Day 12 post-op, requiring multimodal treatment,
including beta-blocker and antiarrhythmic agents. She
was later discharged well on low-dose carbimazole. Her
ultrasound neck showed a normal thyroid gland, and her
thyroid antibodies were negative.
Conclusion:A high level of suspicion is needed to detect thyroiditis
post-parathyroidectomy due to its potential adverse impact
on surgical outcomes. Treatment is mainly symptomatic,
and the disease is self-limiting. Risk factors identified
include secondary/tertiary hyperparathyroidism and
bilateral neck exploration that involves manipulation of
the thyroid gland.
- Full text:2026080417030505965EP_A153.pdf
