Open Access Veselinovic et al., Thyroid Disorders Ther 2013, 2.3 DOI: 10.4172/2167-7948.1000132 Open Access Case Report Volume 2 • Issue 3 • 1000132 Thyroid Disorders Ther ISSN: 2167-7948 JTDT, an open access journal Severe Hypocalcemia in the Postpartum Period: A Rare Case of Primary Hypoparathyroidism and Autoimmune Thyroid Disease Veselinovic N 1 , Pavlovic A 1 , Miljic D 2 *, Popovic V 2 and Sternic N 1 1 Clinic for Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia 2 Clinic for Endocrinology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia *Corresponding author: Miljic D, Clinic for Endocrinology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia, E-mail: draganamiljic@yahoo.com Received August 20, 2013; Accepted September 27, 2013; Published September 30, 2013 Citation: Veselinovic N, Pavlovic A, Miljic D, Popovic V, Sternic N (2013) Severe Hypocalcemia in the Postpartum Period: A Rare Case of Primary Hypoparathyroidism and Autoimmune Thyroid Disease. Thyroid Disorders Ther 2: 132. doi:10.4172/2167-7948.1000132 Copyright: © 2013 Veselinovic N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Insufcient parathyroid hormone (PTH) activity disturbs body calcium homeostasis with inadequate mobilization of calcium from bone matrix, reabsorption from the kidney and decreased synthesis of 1-hydroxyvitamin D, resulting in hypocalcaemia and hyperphosphatemia. Primary hypoparathyroidism remains a rare cause of hypocalcaemia with an estimated prevalence of 7.2 per million [1]. Te electrolyte alterations in hypoparathyroidism mainly afect the neuromuscular system and usually result in spasms, cramps and twitching, but the spectrum of possible clinical presentations ranges from congestive heart failure to syndromes mimicking neurodegenerative disease [2]. Autoimmune hypopyrathyroidism is an extremely rare disorder. Considering post-partum evolution of symptoms and positive anti-thyreoglobuline antibodies, autoimmunity may be the likely underlying mechanism of the disease in our patient. Autoantibodies to CaSR may activate the receptor on PTH cells instead of calcium, resulting in false signaling and inhibition of adequate PTH secretion [3]. CaSR antibodies are found in up to 50% cases of idiopathic hypoparathyroidism but their role in the pathogenesis of the disease is not clear [4]. To the best of our knowledge, this is the frst report of an autoimmune hypoparathyroidism presenting with severe hypocalcaemia in a patient with autoimmune thyroid disease and normal thyroid function during the post-partum period. Our patient presented with neuro-muscular symptoms due to severe hypocalcaemia in unrecognized primary hypoparathyroidism with several distinct features. Here we discuss the pathophysiology and diagnostic aspects of this treatable disease. Case Report A 29-year old woman presented to emergency room with perioral numbness and speech difculty resembling transitory is chemic attack. Symptoms gradually resolved afer one hour. She reported several episodes of carpal spasmsin the last 18 months, starting shortly afer her frst delivery. Her past medical history included euthyroid multinodular goiter diagnosed 5 years earlier. Early development and family history were unremarkable. On admission, she appeared to be in distress. General physical examination was normal except for thyroid enlargement. Neurologic examination indicated markedly reduced muscle tendon refexes with normal muscle strength and tone and otherwise unremarkable examination, with no involuntary movements. Both Chwostek’s and Abstract Although autoimmune hypoparathyroidism is extremely rare in contrast to very common thyroid autoimmune diseases the combination of those two was recently shown to be to some extent higher than previously thought. Flare- ups of autoimmune diseases in the post-partum period are very common, however, to the best of our knowledge, this is the frst report of an autoimmune hypoparathyroidism presenting with severe hypocalcaemia in a patient with autoimmune thyroid disease and normal thyroid function during the post-partum period. We present a case of a young woman with muscle spasms and basal ganglia calcifcations due to severe hypocalcaemia induced by primary hypoparathyroidism. Here we discuss the pathophysiology and diagnostic aspects of this treatable disease. Trousseau’s signs were positive. Brain computed tomography (CT) scan showed bilateral basal ganglia calcifcations (Figure 1). Prolonged QT interval (QTc 0.480s) was observed on the electrocardiography. Transthoracic echocardiography was unremarkable. Laboratory analyses revealed low serum free calcium, high phosphate and normal intact parathyroid hormone (PTH) levels, inadequate for the degree Figure 1: Axial brain CT showing bilateral symmetrical calcifcation in the basal ganglia (putamen) (arrow), with normal appearance of other brain structures. Journal of Thyroid Disorders & Therapy J o u r n a l o f T h y r o i d D i s o r d e r s & T h e r a p y ISSN: 2167-7948