Discontinuation of palopegteriparatide in chronic hypoparathyroidism without rebound hypocalcemia

A woman with chronic hypoparathyroidism following total thyroidectomy was treated with palopegteriparatide, a long-acting parathyroid hormone replacement therapy, for more than 4 years. Previous reports have suggested that stopping parathyroid hormone therapy may lead to severe rebound hypocalcemia and increased calcium requirements due to a "hungry bone syndrome." After discontinuation of palopegteriparatide, the patient resumed conventional treatment with calcium supplements and active vitamin D at doses similar to those used before starting hormone therapy; the alfacalcidol dose was subsequently reduced because of high-normal calcium levels. She remained clinically stable without symptoms of hypocalcemia or hungry bone syndrome, and repeated blood tests showed normal calcium levels throughout follow-up. This case suggests that discontinuation of palopegteriparatide may not necessarily result in major disturbances in calcium balance or increased treatment requirements. The findings provide reassurance that some patients with chronic hypoparathyroidism can transition safely back to conventional therapy after long-term palopegteriparatide treatment.