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Patient: Female, 29-year-old Final Diagnosis: Chronic hypoparathyroidism Symptoms: Muscle cramps • numbness • tingling in fingers Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Unusual or unexpected effect of treatment Background: Hypoparathyroidism remains the only hormone deficiency-related disorder with a standard treatment that is not based on replacing a missing hormone. Growing evidence supports the use of recombinant human parathyroid hormone (PTH), mostly with subcutaneous injections. More recently, some clinicians have administered teriparatide, a pharmaceutical form of PTH, through continuous delivery systems. Case Report: A 31-year-old woman was referred to our department for further evaluation of chronic severe hypocalcemia due to iatrogenic postsurgical hypoparathyroidism. Despite being chronically medicated with high doses of calcium, vitamin D, and subcutaneous teriparatide injections, she still reported symptoms of hypocalcemia on a daily basis and frequently needed treatment with intravenous calcium perfusions. During hospitalization, we ruled out treatment noncompliance and documented 6 episodes of severe hypocalcemia. Our team then decided to implement a continuous subcutaneous perfusion of teriparatide through an insulin pump. After optimizing the infusion rate, no more severe hypocalcemia episodes occurred. Four months after hospital discharge, it was possible to fully suspend oral supplementation therapy, and the patient’s serum calcium level consistently remained within normal range. No other episodes of hypocalcemia occurred. Conclusions: The only way to effectively restore long-term calcium homeostasis in our patient was to start a continuous subcutaneous infusion of teriparatide. There was no need to maintain calcium or vitamin D supplementation and we were able to halve the required daily dose of teriparatide. To our knowledge, this case represents one of the very few reports of successful treatment of hypoparathyroidism with a continuous perfusion of PTH.

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Introduction: The occurrence of nonthyroidal second primary malignancy (NTSPM) in patients with papillary thyroid cancer (PTC) is well documented but epidemiological data are conflicting. Objective: To evaluate the incidence of NTSPM in a large series of patients with PTC and to assess its potential risk factors. Methods: Single-center cohort study with retrospective data collection conducted on consecutive PTC patients diagnosed from 1988-2018 with a minimum follow-up time of 2 years. NTSPM was defined as any primary malignancy with histological confirmation occurring in an anatomical site other than the thyroid. According to the timing of occurrence, NTSPM were subdivided into anachronous, synchronous or metachronous (diagnosed >6 months before, within 6 months and >6 months after PTC diagnosis, respectively). Results: We included 773 individuals (83.3% females), median age at PTC diagnosis was 47.0 (IQR 37.0-58.0) years and median follow-up time was 9.9 (6.2-16.3) years. Incidence of NTSPM was 15.5% (n=120) and its standard incidence ratio (SIR) was higher when compared to the general population (SIR 2.70).Family history of malignancy and younger age at diagnosis were associated respectively with a 206% and 4% increased risk of developing a metachronous neoplasia [HR 2.06 (95% CI 1.10-3.86) and 1.04 (1.02-1.05), respectively]. Conclusion: In our series, the occurrence of NTSPM was not uncommon and its incidence was higher compared to the general population. First degree family history of malignancy was a strong risk factor for multiple primary malignancies.

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