A 49-year-old, otherwise healthy female was admitted to our hospital for thyroidectomy. Postoperatively, presumably due to perioperative hypoperfusion of the parathyroid glands, she developed ‘hungry bone syndrome’, which is characterised by suppressed parathyroid hormone levels, resulting in an increased net bone uptake of calcium and subsequent severe hypocalcaemia [1]. Even with intravenous calcium supplementation, she developed QT prolongation and multiple episodes of torsades de pointes (TdP) ventricular tachycardia without cardiac output (Fig. 1). Isoprenaline was started to increase her heart rate to prevent further TdP. However, despite adequate heart rates (70–100 beats/min) and increasing, yet still subnormal, calcium levels, sustained TdP repeatedly developed, requiring electrocardioversion. She was transferred to a tertiary clinic, where her rhythm was successfully controlled by temporary tachypacing and high-dose beta-blockers. Chronic calcium supplementation eventually normalised her calcium levels and QT time.
Fig. 1
Upper Electrocardiogram demonstrating QT prolongation and ST‑T changes attributable to hypocalcaemia. Lower left Rhythm recording of the development of torsades de pointes ventricular tachycardia. Lower right Graph depicting the serum calcium levels over time
×
Even though hypocalcaemia-induced TdP rarely complicates thyroidectomy [2‐4], this case demonstrates the value of electrocardiographic and electrolyte screening after thyroidectomy and rhythm surveillance in severe hypocalcaemia.
Conflict of interest
Q.A.J. Hagdorn, P. Loh and S. Velthuis declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...
