Skip to main content Skip to main navigation menu Skip to site footer

Recurrent seizures as manifestation of hypoparathyroidism-related hypocalcemia in a patient with post-subtotal thyroidectomy

  • Febrian Daru Setiawan ,
  • Hermina Novida ,


Background: Hypocalcemia, a condition where the serum calcium concentration or total serum calcium is below normal, could be associated with various manifestations including severe symptoms requiring immediate hospitalization. The condition can cause by several causes including iatrogenic thyroidectomy. Here, we report a patient of hypocalcemia associated with hypoparathyroidism due to post-thyroidectomy.

Case presentation: A 32-year-old woman admitted to the hospital complained of stiffness and tingling in the extremities accompanied by recurrent seizures. The serum calcium level was low and this hypocalcemia condition was associated with low parathyroid hormone levels after subtotal thyroidectomy surgery. Laboratory examination indicated calcium 4.8 mg/dL and parathyroid hormone 2.21 pg/ml. The patient had bradycardia with prolonged QT on electrocardiography (ECG) and developed cataracts in both eyes which could be associated with chronic hypocalcemia. The patient's condition improved after correction of hypocalcemia. After discharge, the patient was given calcium and levothyroxine supplementation due to hypothyroid conditions.

Conclusion: The hypocalcemia condition in the patient was associated with low parathyroid hormone level post-subtotal thyroidectomy surgery. This case highlights the impotence of detailed analyses of hormonal, radiological and histological investigations of patients with thyroid gland diseases to diagnose such conditions early and to ensure timely management.


  1. Bove-Fenderson E, Mannstadt M. Hypocalcemic disorders. Best Pract & Res Clin Endocrinol & Metab [Internet]. 2018;32(5):639–56. Available from:
  2. Reber PM, Heath H. Hypocalcemic emergencies. Med Clin North Am [Internet]. 1995;79(1):93–106. Available from:
  3. Cooper MS, Gittoes NJL. Diagnosis and management of hypocalcaemia. BMJ [Internet]. 2008 Jun 7;336(7656):1298–302. Available from:
  4. Vasileiadis I, Charitoudis G, Vasileiadis D, Kykalos S, Karatzas T. Clinicopathological characteristics of incidental parathyroidectomy after total thyroidectomy: The effect on hypocalcemia. A retrospective cohort study. Int J Surg [Internet]. 2018;55:167–74. Available from:
  5. Lianto AW, Bas BMRR, Adiwinoto RD, Libriansyah L. Diagnostic and Management Problems of a Patient with Severe Life-Threatening Acute Hypocalcemia: A Case Report. Biomol Heal Sci J [Internet]. 2022;5(1):67–70. Available from:
  6. Pu F, Chen N, Xue S. Calcium intake, calcium homeostasis and health. Food Sci Hum Wellness [Internet]. 2016;5(1):8–16. Available from:
  7. Tohme JF, Bilezikian JP. Diagnosis and Treatment of Hypocalcemic Emergencies. Endocrinologist [Internet]. 1996;6(1):10–8. Available from:
  8. Al Qubaisi M, Haigh PI. Hypocalcemia after Total Thyroidectomy in Graves Disease. Perm J [Internet]. 2019/05/17. 2019;23:18–188. Available from:
  9. Mahawish K, Otaiku O. The patient presenting with acute hemiparesis. Acute Med J [Internet]. 2012;11(1):33–8. Available from:
  10. Daba KT, Weldemichael DK, Mulugeta GA. Bilateral hypocalcemic cataract after total thyroidectomy in a young woman: case report. BMC Ophthalmol [Internet]. 2019 Nov 21;19(1):233. Available from:
  11. Febrianto D, Novida H. Diagnostic and management problems of hyperthyroidism in a patient with testicular seminoma. Curr Intern Med Res Pract Surabaya J [Internet]. 2022;3(1):16. Available from:
  12. Hakim RA, Massora S, Lutfi D, Novida H. A Patient With Graves’ Disease And Thyroid-Associated Orbitopathy Undergoing Radioactive Iodine in Dr. Soetomo General Academic Hospital, Surabaya. Biomol Heal Sci J [Internet]. 2021;4(1):48. Available from:
  13. Kandinata SG, Soelistijo SA, Amrita PNA. Graves’ Disease Presenting as Autoimmune Hemolytic Anemia. Am J Case Rep [Internet]. 2021 Apr 23;22:e930705–e930705. Available from:
  14. Wironegoro R, Baskoro A, Effendi C, Pranoto A. Immunoglobulin-E and Thyroid-Stimulating Hormone Receptor Antibody in Graves’ disease with Atopy. Supl 2 [Internet]. 2021;129(s2). Available from:
  15. Joint Meeting of the German Association of Endocrine Surgeons (CAEK) and the British Association of Endocrine and Thyroid Surgeons (BAETS). Langenbeck’s Arch Surg [Internet]. 2016;401(7):1045–91. Available from:
  16. Reksoprawiro S. Suppurative Thyroiditis with Gas Formation. Asian J Surg [Internet]. 2003;26(3):180–2. Available from:
  17. Sutantoyo FF, Sugianto P. Secondary Fahr’s disease: A differential to be considered in a COVID-19 pneumonia patient with neuropsychiatric presentations. Rom J Neurol [Internet]. 2021;20(4):501–4. Available from:
  18. Ritter K, Elfenbein D, Schneider DF, Chen H, Sippel RS. Hypoparathyroidism after total thyroidectomy: incidence and resolution. J Surg Res [Internet]. 2015/04/21. 2015 Aug;197(2):348–53. Available from:
  19. Bollerslev J, Rejnmark L, Marcocci C, Shoback DM, Sitges-Serra A, van Biesen W, et al. European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults. Eur J Endocrinol [Internet]. 2015;173(2):G1–20. Available from:
  20. Raffaelli M, De Crea C, D’Amato G, Moscato U, Bellantone C, Carrozza C, et al. Post-thyroidectomy hypocalcemia is related to parathyroid dysfunction even in patients with normal parathyroid hormone concentrations early after surgery. Surgery [Internet]. 2016;159(1):78–85. Available from:
  21. Lee JW, Kim JK, Kwon H, Lim W, Moon BI, Paik NS. Routine low-dose calcium supplementation after thyroidectomy does not reduce the rate of symptomatic hypocalcemia: a prospective randomized trial. Ann Surg Treat Res [Internet]. 2019/03/28. 2019 Apr;96(4):177–84. Available from:
  22. Mahmud AA, Anu UH, Foysal KA, Hasan M, Sazib SM, Ragib AA, et al. Elevated serum malondialdehyde (MDA), insulin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid-stimulating hormone (TSH), and reduced antioxidant vitamins in polycystic ovarian syndrome patients. Narra J [Internet]. 2022;2(1). Available from:
  23. Tecilazich F, Formenti AM, Frara S, Giubbini R, Giustina A. Treatment of hypoparathyroidism. Best Pract & Res Clin Endocrinol & Metab [Internet]. 2018;32(6):955–64. Available from:
  24. Balasubramanian SP. Iatrogenic/post-surgical hypoparathyroidism: where do we go from here? Endocrine [Internet]. 2014;47(2):357–9. Available from:

How to Cite

Setiawan, F. D., & Novida, H. . (2022). Recurrent seizures as manifestation of hypoparathyroidism-related hypocalcemia in a patient with post-subtotal thyroidectomy. Bali Medical Journal, 11(3), 1780–1783.




Search Panel

Febrian Daru Setiawan
Google Scholar
BMJ Journal

Hermina Novida
Google Scholar
BMJ Journal