[Asymptomatic encephalic calcifications in postsurgical hypoparathyroidism]

Encephalic calcifications (EC) are a frequent finding in neuroimaging of CT scans, which have many causes,both symptomatic and asymptomatic. This paper has aimed to report a series of patients who had had a previous thyroidectomy years earlier in whom the presence of hypoparathyroidism (HP) EC and their clinical manifestations had been analyzed.

A group of 38 women who had undergone a thyroidectomy from 14 to 45 years ago were evaluated. The EC was mild in 2 cases, located exclusively in the pale globe and putamen. It was moderate in two other patients, the calcinosis spreading towards the caudate nucleus, and one patient was considered severe or very extended, affecting the basal ganglia, cerebellum and white matter of semioval centers.

Six patients (15%) had HP; five of them (13%) with EC. The neurological examination and the UPDRS scale were normal, including negative Chvostek and Trousseau signs. Cognition was evaluated with: Mini-Mental State Examination, Clock Drawing test, Alzheimer's Disease Assessment Scale-cognitive, Trail Making Test Part A and B and the Clinical Dementia Rating, of which were normal. In these six patients, serum calcium (Ca) and parathormone (PTH) levels were reduced and phosphorus values increased.

It is likely that the EC are sub-diagnosed in postsurgical HP due to the absence of symptoms. There is still an ongoing debate on the appearance of symptoms and extension of EC, possibly when the Ca and PTH variables only have a moderate reduction, corresponding to a variable that avoids manifestations.