Diffuse intracranial calcifications in a patient with untreated postoperative

摘要

A 68-year-old woman presented to hospital after a fall. She had undergone a total thyroidec-tomy more than 20 years previously. Her neurologic examination was normal. Computed tomography scans of her head, done to exclude intracranial bleed, showed symmetric parenchymal calcification in the basal ganglia (Figure 1A) and cerebellum (Figure IB). Given the patient's history of thyroidec-tomy, we suspected hypoparathyroidism and arranged a series of laboratory tests. These showed an ionized calcium level of 0.75 (normal 1.15-1.35) mmol/L, and a phosphate level of 1.51 (normal 0.87-1.52) mmol/L. Her parathyroid hormone level was undetectable at less than 0.6 (normal 1.4-7.6) pmol/L and her thyroid-stimulating hormone level was 0.38 (normal 0.5-5.0) mlU/L. The presumptive diagnosis for the intracranial calcifications was chronic hypocalcemia caused by untreated hypoparathyroidism after total thyroidectomy.