Transient teriparatide for postoperative hypocalcemia with hungry bone features

Postoperative hypocalcemia after parathyroidectomy may be challenging to manage. We report a 50-year-old man with severe primary hyperparathyroidism, very high parathyroid hormone levels, markedly elevated alkaline phosphatase and extensive skeletal disease, including a brown tumor with pathological fracture. Following parathyroidectomy, he developed persistent postoperative hypocalcemia with biochemical features suggestive of both transient postoperative hypoparathyroidism and hungry bone physiology. Despite high-dose calcium, calcitriol, and electrolyte replacement, hypocalcemia persisted, requiring intensive care unit admission and prolonged intravenous supplementation. Teriparatide was initiated on postoperative day 11 at a dose of 20 µg twice daily, subsequently reduced to 20 µg once daily. Thereafter, calcium levels progressively normalized, allowing discontinuation of intravenous supplementation and early hospital discharge. A short course was associated with sustained calcium-phosphate stabilization without recurrence of hypocalcemia during follow-up. This case highlights the potential role of short-term teriparatide as rescue therapy in selected patients with persistent postoperative hypocalcemia and hungry bone features.