Introduction
We are here reporting a case of long standing untreated postoperative hypoparathyroidism presenting as reversible cardiomyopathy in and adult.
Case report A 45 yrs old female presented with dyspnea at rest, orthopnea, chest pain & palpitations for 10 days. Patient was diagnosed as a case of cardiomyopathy for the last 3 years for which she received treatment from a local physician which she stopped 1 week before presentation. Patient had undergone total thyroidectomy for multinodular goitre 5 years back and kept on levothyroxine 25mcg. She never underwent thyroid function test after that. Patient had history of numbness and tingling of extremities, perioral parasthesias and intermittent abnormal tonic posturing of hands since 2 years. She had generalized tonic clonic seizures twice one week back for which she was treated outside.
Examination revealed pallor and tongue bite with a thyroidectomy scar, bilateral pitting pedal edema, tachypnea, elevated JVP, S3 gallop with a systolic murmur at apex and bilateral basal crepetations. Her TrousseausÂ’ sign and Chvosteks sign were positive. Her serum calcium was 4.1mg/dl, magnesium was 1.2mg/dl and Phosphorus was 6.97mg/dl which normalized in 5 days after treatment.
Echocardiography showed global hypokinesia with ejection fraction of 37 % at the time of admission. Her echocardiography revealed normal LV function with ejection fraction of 55% following 3 weeks of treatment of hypocalcemia with calcium, magnesium, 25 OH Viamin D, 1,25 OH vitamin D, thiazides and phosphate binder.
Conclusion: Recognition of hypocalcemia in patients with cardiomyopathy is important as it is highly treatable.
Key words: hypocalcemia, hypoparathyroidism, cardiomyopathy, reversible
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