Off-label palopegteriparatide for severe pediatric postsurgical hypocalcemia.
Pilar Pérez Reyes, Ángel Rebollo Román, María Rosa Alhambra Expósito et al.
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Case in brief
A 14-year-old boy with Graves’ disease developed profound hypocalcemia after total thyroidectomy, with serum calcium 5.9 mg/dL, ionized calcium 0.83 mmol/L, and undetectable parathyroid hormone. Hypocalcemia, hyperphosphatemia, and treatment requirements persisted despite intravenous and high-dose oral calcium plus calcitriol. Following multidisciplinary assessment and family consent, he received off-label subcutaneous palopegteriparatide. Calcium improved within 48 hours; intravenous calcium was stopped after 5 days, and calcitriol, sevelamer, and calcium acetate were discontinued within 11 days. Treatment was well tolerated.
What made this case unusual
The report describes off-label use of a long-acting PTH(1-34) prodrug as rescue therapy for severe, refractory postsurgical hypocalcemia in a child.
Diagnostic / clinical pearl
In severe post-thyroidectomy hypocalcemia with undetectable PTH that remains poorly controlled despite calcium and calcitriol, PTH replacement may be considered as a rescue strategy in selected children.