Seizures and hypoparathyroidism post-thyroidectomy: Fahr's syndrome

Abstract

Fahr's syndrome is a rare neurological condition marked by unusual calcifications in the basal ganglia and other brain regions, often resulting from metabolic disorders, such as hypoparathyroidism. Secondary hypoparathyroidism, a frequent complication of total thyroidectomy, can lead to Fahr's syndrome, manifesting as movement disorders, seizures, psychiatric symptoms and indications of calcium deficiency. This case report discusses a woman in her mid-30s who developed Fahr's syndrome due to secondary hypoparathyroidism after total thyroidectomy. She exhibited signs of calcium deficiency and had a history of seizures diagnosed a few years postsurgery, without any movement disorders or psychiatric symptoms. Her lab results showed low calcium levels, elevated phosphate and high thyroid-stimulating hormone levels. Imaging revealed bilateral calcifications in the basal ganglia, dentate nucleus and cerebral hemispheres. Treatment with intravenous calcium gluconate, calcitriol and thyroxine significantly improved the patient's symptoms. This case underscores the necessity of monitoring calcium and phosphate levels in patients after thyroidectomy and highlights the possibility of Fahr's syndrome presenting solely with seizures. The early detection and diagnosis of this condition are crucial for preventing further neurological damage and enhancing patient outcomes.

Keywords: Calcium and bone; Epilepsy and seizures; Head and neck surgery; Thyroid disease.