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Post-thyroidectomy hypocalcemia exacerbated by chyle leak

Naweed Alzaman

Naweed Alzaman Division of Endocrinology, Diabetes, and Metabolism, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts, 02111, USA

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Anastassios G Pittas

Anastassios G Pittas Division of Endocrinology, Diabetes, and Metabolism, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts, 02111, USA

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Miriam O'Leary

Miriam O'Leary Department of Otolaryngology, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts, 02111, USA

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Lisa Ceglia

Lisa Ceglia Division of Endocrinology, Diabetes, and Metabolism, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts, 02111, USA

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Summary

Transient hypocalcemia after thyroidectomy is not uncommon and the risk increases with the extent of neck surgery. We report a case of severe and prolonged hypocalcemia after total thyroidectomy complicated by thoracic duct injury. Hypoparathyroidism and thoracic duct injury are potential complications following total thyroidectomy with extensive lymph node dissection. This case suggested that having both conditions may complicate treatment of hypoparathyroid-induced hypocalcemia by way of losses of calcium and vitamin D in the chyle leak.

Learning points

This report highlights chyle leak as an uncommon cause of prolonged hypocalcemia in patients who have undergone extensive neck surgery.
Chyle has an electrolyte concentration similar to that of plasma.
Medical treatment options for a chyle leak include fat-free oral diet or parenteral nutrition without oral intake, pharmacological treatment (primarily octreotide).