I got a total thyroidectomy surgery in April 2018 to treat papillary carcinoma in two nodules where the biggest was 9 mm of diameter. The surgery was performed at Kings College Hospital London. I developed hypocalcemia after surgery and I having taking a high dose of Adcal+D3 (6/day) and Alphacalcidol (3/day) . After 4 months PTH reached to 15 mmol/L, however, I got last month PTH <5.

What could be the possible reasons for PTH dropping?
How can I improve the Parathyroid recovery and avoid permanent Hypoparathyroidism?
Dr. Philip Kelly
Dr. Philip Kelly
Endocrinologist, Internist
Thanks for the question, it is a little difficult to be certain without knowing everything but the most likely reason why the PTH would be low, in this situation, is that the calcium is high in the reference range or above that range. Alfacalcidol and calcium could do that and your own PTH would be suppressed. But one would really need to know all the details and it is important to know what has happened.

Dr. Rajeev Kumar
Dr. Rajeev Kumar
From limited information It appear to be the case of iatrogenic hypoparathyroidism. Treatment will be Alfacalcidol along with calcium (1 gm elemental calcium per day). Sometime thiazide diuretic may be required to reduced calcium exception in urine. Aim would be to keep calcium towards the low normal side.

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