Off-label palopegteriparatide for severe pediatric postsurgical hypocalcemia

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ID: 329776
2026
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Abstract
Abstract Hypoparathyroidism is the most common complication after total thyroidectomy and may be particularly severe in pediatric Graves’ disease. We report the case of a 14-year-old boy with Graves’ disease who developed profound postoperative hypocalcemia after total thyroidectomy, with serum calcium 5.9 mg/dL, ionized calcium 0.83 mmol/L, and undetectable parathyroid hormone. Despite intravenous and high-dose oral calcium plus calcitriol, biochemical control remained poor, with persistent hypocalcemia, hyperphosphatemia, and ongoing treatment requirements after 16 days. Off-label subcutaneous palopegteriparatide, a long-acting PTH(1-34) prodrug, was started after multidisciplinary assessment and informed family consent. Serum calcium improved within 48 h, intravenous calcium was stopped after 5 days, and calcitriol, sevelamer, and calcium acetate were discontinued within 11 days. Treatment was well tolerated. This case suggests that early PTH replacement may be a useful rescue strategy in selected children with severe refractory post-thyroidectomy hypocalcemia.
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Authors Pilar Pérez Reyes, Ángel Rebollo Román, María Rosa Alhambra Expósito, Jose Carlos Padillo Cuenca, Carmen Serrano Laguna, Paloma Moreno Moreno, Juan Manuel Rodríguez Camacho, María Ángeles Gálvez Moreno
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Journal european journal of endocrinology
Year 2026
DOI
10.1093/ejendo/lvag186
URL
https://doi.org/10.1093/ejendo/lvag186
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