Surgical case reports · 2025
Paradoxical Elevation of Parathyroid Hormone Levels following Preoperative Native Vitamin D Supplementation in a Patient with Graves' Disease Undergoing Total Thyroidectomy: A Case Report.
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Yamashita Hiroyuki, Shindo Hisakazu, Mori Yusuke, Tatsushima Daisuke, Fukuda Takashi, Tachibana Seigo, Takahashi Hiroshi, Nagayama Yuji, Sato Shinya
Аннотация
INTRODUCTION: Hypocalcemia is a common complication after total thyroidectomy, particularly in patients with Graves' disease and high bone turnover. Preoperative vitamin D deficiency is a known risk factor for postoperative hypocalcemia; however, the effects of vitamin D supplementation remain controversial. This is the first study to document a paradoxical increase in parathyroid hormone (PTH) levels after preoperative vitamin D supplementation in a patient undergoing total thyroidectomy.
CASE PRESENTATION: We report the case of a 68-year-old woman with Graves' disease and coexisting thyroid cancer who received native vitamin D (2000 IU/day) for 4 weeks before surgery. This unexpectedly resulted in a marked increase in PTH levels and bone formation markers, suggesting the worsening of secondary hyperparathyroidism. Interestingly, fibroblast growth factor 23 levels remained unchanged despite an increase in PTH and 1,25-dihydroxyvitamin D levels. Postoperatively, she developed transient hypoparathyroidism.
CONCLUSIONS: Native vitamin D supplementation may, paradoxically, worsen secondary hyperparathyroidism in some patients, highlighting the need for careful preoperative metabolic assessment and individualized management strategies.
CASE PRESENTATION: We report the case of a 68-year-old woman with Graves' disease and coexisting thyroid cancer who received native vitamin D (2000 IU/day) for 4 weeks before surgery. This unexpectedly resulted in a marked increase in PTH levels and bone formation markers, suggesting the worsening of secondary hyperparathyroidism. Interestingly, fibroblast growth factor 23 levels remained unchanged despite an increase in PTH and 1,25-dihydroxyvitamin D levels. Postoperatively, she developed transient hypoparathyroidism.
CONCLUSIONS: Native vitamin D supplementation may, paradoxically, worsen secondary hyperparathyroidism in some patients, highlighting the need for careful preoperative metabolic assessment and individualized management strategies.