Post-total thyroidectomy, the patient's parathyroids were inadvertently removed and confirmed on pathology. Sestamibi scan is not applicable. What is the correct long-term management of permanent hypoparathyroidism?
- A Oral calcium, active vitamin D, and thiazide diuretic (to reduce urinary calcium loss) ✓
- B Oral calcium and active vitamin D (calcitriol/alfacalcidol) supplementation
- C PTH injection subcutaneously twice daily (recombinant PTH 1-34 or 1-84)
- D Dietary calcium supplementation alone
Correct answer: A. Oral calcium, active vitamin D, and thiazide diuretic (to reduce urinary calcium loss)
Explanation
Permanent hypoparathyroidism is managed with oral calcium supplements plus active vitamin D (calcitriol/alfacalcidol) to maintain serum calcium at the low-normal range. Adding a thiazide diuretic (e.g., hydrochlorothiazide) reduces urinary calcium excretion, limiting hypercalciuria — a major complication of high-dose supplementation that leads to nephrocalcinosis and renal stones. This three-drug combination is the evidence-based long-term regimen.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.