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A teenage boy with hypocalcemia after radioablation for Graves’ disease

  • Oksana Lazareva , Aristotle Panayiotopoulos , Irina Kazachkova and Elka Jacobson-Dickman EMAIL logo
Published/Copyright: November 7, 2013
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 27 Issue 3-4

Abstract

Excessive thyroid hormone production, as seen in Graves’ disease, stimulates osteoblast-mediated bone turnover in favor of bone resorption. Acute reversal of bone resorption can lead to hungry bone syndrome (HBS), a state of rapid calcium deposition into newly synthesized osteoid resulting in hypocalcemia. Hypocalcemia due to subsequent functional or relative hypoparathyroidism is a recognized complication of therapy for Graves’ disease. HBS is most recognized as an outcome of rapid correction of vitamin D deficiency or of acute hypoparathyroidism in cases of parathyroid gland function disruption after surgical removal of the thyroid. We report the case of an adolescent boy with Graves’ disease who presented with hypocalcemia after radioactive iodine (131I) therapy due to HBS. Our report highlights the risk of HBS and severe hypocalcemia following treatment for Graves’ disease in pediatric patients and also underscores the importance of pretreatment assessment and intervention for coexistent vitamin D deficiency.

Keywords: Graves’ disease; hungry bone syndrome; hypocalcemia
Corresponding author: Elka Jacobson-Dickman, MD, Division of Pediatric Endocrinology, Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 49, Brooklyn, NY 11203, USA, E-mail:
aOksana Lazareva and Aristotle Panayiotopoulos are co-first authors.

Acknowledgments

The authors acknowledge Dr. Harald Jüppner for his generous guidance in the preparation of this manuscript.

References

1. Kansra S, Devidayal, Suri D, Singh M. Hypocalcaemia following therapy of thyrotoxicosis in an infant. Acta Paediatr 2006;95:375–7.Search in Google Scholar

2. Rivkees SA, Dinauer C. An optimal treatment for pediatric Graves’ disease is radioiodine. J Clin Endocrinol Metab 2007;92:797–800.Search in Google Scholar

3. Sosa JA, Tuggle CT, Wang TS, Thomas DC, Boudourakis L, et al. Clinical and economic outcomes of thyroid and parathyroid surgery in children. J Clin Endocrinol Metab 2008;93:3058–65.Search in Google Scholar

4. Ross DS. Hyperthyroidism, thyroid hormone therapy, and bone. Thyroid 1994;4:319–26.Search in Google Scholar

5. Karga H, Papapetrou PD, Korakovouni A, Papandroulaki F, Polymeris A, et al. Bone mineral density in hyperthyroidism. Clin Endocrinol (Oxf) 2004;61:466–72.Search in Google Scholar

6. Chapman EM. History of the discovery and early use of radioactive iodine. J Am Med Assoc 1983;250:2042–4.Search in Google Scholar

7. Clark JD, Gelfand MJ, Elgazzar AH. Iodine-131 therapy of hyperthyroidism in pediatric patients. J Nucl Med 1995;36:442–5.Search in Google Scholar

8. Levy WJ, Schumacher OP, Gupta M. Treatment of childhood Graves’ disease. A review with emphasis on radioiodine treatment. Cleve Clin J Med 1988;55:373–82.Search in Google Scholar

9. McCormack S, Mitchell DM, Woo M, Levitsky LL, Ross DS, et al. Radioactive iodine for hyperthyroidism in children and adolescents: referral rate and response to treatment. Clin Endocrinol (Oxf) 2009;71:884–91.Search in Google Scholar

10. Read CH Jr, Tansey MJ, Menda Y. A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves’ patients. J Clin Endocrinol Metab 2004;89:4229–33.Search in Google Scholar

11. Nebesio TD, Siddiqui AR, Pescovitz OH, Eugster EA. Time course to hypothyroidism after fixed-dose radioablation therapy of Graves’ disease in children. J Pediatr 2002;141:99–103.Search in Google Scholar

12. Rivkees SA, Cornelius EA. Influence of iodine-131 dose on the outcome of hyperthyroidism in children. Pediatrics 2003;111:745–9.Search in Google Scholar

13. Rivkees SA, Sklar C, Freemark M. Clinical review 99: the management of Graves’ disease in children, with special emphasis on radioiodine treatment. J Clin Endocrinol Metab 1998;83:3767–76.Search in Google Scholar

14. Bartalena L, Marcocci C, Bogazzi F, Manetti L, Tanda ML, et al. Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy. N Engl J Med 1998;338:73–8.Search in Google Scholar

15. Bondeson AG, Bondeson L, Thompson NW. Hyperparathyroidism after treatment with radioactive iodine: not only a coincidence? Surgery 1989;106:1025–7.Search in Google Scholar

16. Colaco SM, Si M, Reiff E, Clark OH. Hyperparathyroidism after radioactive iodine therapy. Am J Surg 2007;194:323–7.Search in Google Scholar

17. Fulop M. Hypoparathyroidism after 131 I therapy. Ann Intern Med 1971;75:808.Search in Google Scholar

18. Winslow CP, Meyers AD. Hypocalcemia as a complication of radioiodine therapy. Am J Otolaryngol 1998;19:401–3.Search in Google Scholar

19. See AC, Soo KC. Hypocalcaemia following thyroidectomy for thyrotoxicosis. Br J Surg 1997;84:95–7.Search in Google Scholar

20. Sperling MA. Pediatric endocrinology, 3rd ed. Philadelphia: Saunders Elsevier; 2008.Search in Google Scholar

21. Abu EO, Bord S, Horner A, Chatterjee VK, Compston JE. The expression of thyroid hormone receptors in human bone. Bone 1997;21:137–42.Search in Google Scholar

22. Abe E, Marians RC, Yu W, Wu XB, Ando T, et al. TSH is a negative regulator of skeletal remodeling. Cell 2003;115:151–62.Search in Google Scholar

23. Bauer DC. Bone: does TSH concentration influence skeletal health? Nat Rev Endocrinol 2009;5:245–6.Search in Google Scholar

24. Witteveen JE, van Thiel S, Romijn JA, Hamdy NA. Therapy of endocrine disease: hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature. Eur J Endocrinol 2013;168:R45–53.Search in Google Scholar

25. Albright F, Reifenstein EC, Jr. The parathyroid glands and metabolic bone disease. Wilkins W, editor. Baltimore, MD, USA: The Williams & Wilkins Co., 1948.Search in Google Scholar

26. Brasier AR, Nussbaum SR. Hungry bone syndrome: clinical and biochemical predictors of its occurrence after parathyroid surgery. Am J Med 1988;84:654–60.Search in Google Scholar

27. Dent CE, Harper CM. Hypoparathyroid tetany (following thyroidectomy) apparently resistant to vitamin D. Proc R Soc Med 1958;51:489–90.Search in Google Scholar

28. Jones RM, Davidson CM. Thyrotoxicosis and the hungry bone syndrome: a cause of postoperative tetany. J R Coll Surg Edinb 1987;32:24–8.Search in Google Scholar

29. Dembinski TC, Yatscoff RW, Blandford DE. Thyrotoxicosis and hungry bone syndrome – a cause of posttreatment hypocalcemia. Clin Biochem 1994;27:69–74.Search in Google Scholar

30. Grieff M. The hungry bone syndrome after medical treatment of thyrotoxicosis. Ann Intern Med 2003;139:706–7.Search in Google Scholar

Received: 2013-8-5
Accepted: 2013-10-9
Published Online: 2013-11-07
Published in Print: 2014-03-01

©2014 by Walter de Gruyter Berlin Boston

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https://doi.org/10.1515/jpem-2013-0322
Keywords for this article
Graves’ disease; hungry bone syndrome; hypocalcemia

Articles in the same Issue

  1. Masthead
  2. Masthead
  3. Images in pediatric endocrinology
  4. Leprechaunism (Donohue syndrome): report of a case in a newborn
  5. Original articles
  6. Children and adolescents with type 1 diabetes in Germany are more overweight than healthy controls: results comparing DPV database and CrescNet database
  7. Age of onset of pubertal maturation of Thai boys
  8. Plasma leptin and adiponectin concentrations correlate with cardiometabolic risk and systemic inflammation in healthy, non-obese children
  9. Early differentiation between good and poor response to growth hormone therapy in short children born small for gestational age (SGA) to improve the outcome of poor responders
  10. Children and adolescents with type 1 diabetes mellitus have a sixfold greater risk for prolonged QTc interval
  11. Effect of micronutrient supplementation on height velocity of underprivileged girls in comparison with un-supplemented healthy controls
  12. Insulin resistance in young adults born small for gestational age (SGA)
  13. The effect of childhood obesity on cardiac functions
  14. Adiponectin serum concentrations in newborn at delivery appear to be of fetal origin
  15. Thalassaemic Osteopathy: a cross-sectional preliminary study from Sri Lanka
  16. Health-related quality of life in Turner syndrome and the influence of key features
  17. Clinical analysis on 33 patients with hypothalamic syndrome in Chinese children
  18. The relationship between thyroid dose and diagnosis of primary hypothyroidism in pediatric brain tumor patients receiving craniospinal irradiation
  19. Molecular characterization of Chilean patients with a clinical diagnosis of Noonan syndrome
  20. Expensive therapies in children: benefit versus cost of combined treatment of recombinant human growth hormone and gonadotropin-releasing hormone analogue in girls with poor height potential
  21. The absence of mutations in homeobox candidate genes HOXA3, HOXB3, HOXD3 and PITX2 in familial and sporadic thyroid hemiagenesis
  22. A truncating DUOX2 mutation (R434X) causes severe congenital hypothyroidism
  23. Heterozygous GHR gene mutation in a child with idiopathic short stature
  24. A novel compound mutation of CYP27B1 in a Chinese family with vitamin D-dependent rickets type 1A
  25. A de novo mutation of DAX1 in a boy with congenital adrenal hypoplasia without hypogonadotropic hypogonadism
  26. Patient reports
  27. Hypercalcemia and osteolytic lesions as presenting symptoms of acute lymphoblastic leukemia in childhood. The use of zoledronic acid and review of the literature
  28. Preterm ovarian hyperstimulation syndrome presented with vaginal bleeding: a case report
  29. Pituitary stalk lesion in a 13-year-old female
  30. Radiologic manifestation of a BCS1L-mutated patient
  31. Permanent neonatal diabetes mellitus caused by a novel mutation in the KCNJ11 gene
  32. NKX2-1 mutations in brain-lung-thyroid syndrome: a case series of four patients
  33. A teenage boy with hypocalcemia after radioablation for Graves’ disease
  34. Short communication
  35. A common thyroid peroxidase gene mutation (G319R) in Turkish patients with congenital hypothyroidism could be due to a founder effect
  36. Letter to the Editor
  37. Endometriosis and migraine: what is there behind the scenes?
  38. 10.1515/jpem-2014-0999
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