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Kindly explain the management for low calcium in a thyroid patient?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

What can be done for low calcium in a thyroid patient?

Answered by Dr. Mohammad Rajja

Hello,

Welcome to icliniq.com.

Is it possible you can do histopathology of thyroid gland to rule out? You have many metabolic disorders that you need correction (attachment removed to protect patient identity).

The Probable causes

Relative hypocalcemia Thyoid Disorder

Investigations to be done

Histopatholgy of thyroid and parathyroid Gland MRI Thyroid Gland Collor Dopller Thyroid Gland

Differential diagnosis

Relative Hypocalcemia
Thyroid Carcinomatous change

Probable diagnosis

Thyroiditis

Treatment plan

Tab Zecal MAX 1 Tab po od 1 month Salt added food Syp Potklor 10 ml Po bd with glass of juice

Preventive measures

Steroid Chemotherapy

Regarding follow up

With report

Patient's Query

Hi doctor,

Thanks for your reply. This makes a lot of sense. The report belongs to my uncle. He is not taking anything for thyroid or calcium currently. He is only taking Valparin 500 regularly for the jerking which used to happen earlier. Do we need to get parathyroid gland test? Does he need a thyroid medicine along with Zacal?

Answered by Dr. Mohammad Rajja

Hi,

Welcome back to icliniq.com.

Yes, he has hypocalcemia. I have seen his report (attachment removed to protect patient identity). You have to use Calcium with Thyroid medicine. His TSH hormone is high that means he have low thyroxine. It is better you can chek T4 level too. Yes, calcium level is related with parathyroid hormone level. However, decreased calcium is some time related with deficiency of calcium in diet. Currently, must needed medicine is tablet Zecal MAX / calcium D3 1 tablet OD for 1 month. Reduced calcium level is asaociated with much more seasure we call it tetany (not tetanus). I think you can start Thyronorm/Thyroxin up to 2.1 mcg/kg. Tablet Thyronorm 25 mcg one tablet OD continue in empty stomach. If it looks like he is not taking calcium well then, start the tablet Calcium with D3.

Valporine also causes hypocalcemia. Decrease level of calcium. If there is no history of recurrent hypocalcemia then wait for 20 days. Take calcium then test calcium report. If again, calcium is low then check parathormone.

The Probable causes

Hypothyroidism

Investigations to be done

T4 Parathormone

Differential diagnosis

Hypocalcemia

Probable diagnosis

Hypocalcemia

Treatment plan

Calcium Thyroxin

Preventive measures

Calcium

Regarding follow up

With report

Answered byDr. Mohammad Rajja

Medically reviewed byDr. Divya Banu M

Published At June 20, 2020
Reviewed AtJune 20, 2020

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Mohammad Rajja
Dr. Mohammad Rajja

General Practitioner

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