{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T05:02:12Z","timestamp":1784869332421,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Restoration of parathyroid hormone (PTH) to the normal range following total thyroidectomy is conventionally regarded as an indicator of functional recovery of the parathyroid glands. Nevertheless, a subset of patients develop hypocalcemia upon withdrawal of supplementation. This report describes a case in which PTH normalized postoperatively yet calcium supplements could not be discontinued for three years, and discusses the underlying mechanisms and management strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 40-year-old woman with multifocal papillary thyroid carcinoma harboring the BRAF V600E mutation underwent total thyroidectomy with bilateral level VI lymph node dissection. The patient had a background of Hashimoto\u2019s thyroiditis (thyroglobulin antibody 225.30 IU\/mL, thyroid peroxidase antibody 144.40 IU\/mL). Preoperative serum calcium and PTH were within normal limits, but 25-hydroxyvitamin D was severely deficient (12.8 ng\/mL). On postoperative day 1, hypocalcemic symptoms accompanied by a decline in serum calcium occurred and resolved after intravenous calcium administration. PTH transiently rose to 70.8 pg\/mL on postoperative day 3 but fell to 3.0 pg\/mL by one month after surgery. At three months postoperatively, PTH recovered to 26.7 pg\/mL and remained consistently normal over the subsequent three years. However, repeated attempts to taper or discontinue calcium and active vitamin D at 3, 5, and 18 months postoperatively, as well as on multiple later occasions-provoked numbness of the hands and perioral region within 4\u20137 days. Emergency laboratory evaluations consistently revealed decreased serum calcium without a compensatory rise in PTH. At three years after surgery, the patient still depends on oral calcium supplementation to maintain normocalcemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Normal basal PTH levels do not exclude parathyroid reserve insufficiency. In this patient, preoperative vitamin D deficiency may have predisposed to an osteomalacic state, potentially generating a persistent skeletal calcium demand when combined with a limited PTH stress response. We hypothesize that this represents a phenotype of \u2018bone hunger syndrome with parathyroid reserve insufficiency\u2019. Such patients require long-term individualized calcium replacement, and assessment of the calcium stress response facilitates precise phenotyping. However, further studies with objective biomarkers are needed to validate this hypothesis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1901308","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T04:23:37Z","timestamp":1784867017000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent calcium dependence after total thyroidectomy: a hypothesis of bone hunger syndrome with parathyroid reserve insufficiency in the setting of normalized parathyroid hormone -\u00a0a case report and literature review"],"prefix":"10.3389","volume":"17","author":[{"given":"Wei","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Thyroid and Breast Surgery, Ma\u2019anshan People\u2019s Hospital","place":["Ma\u2019anshan, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Thyroid and Breast Surgery, Ma\u2019anshan People\u2019s Hospital","place":["Ma\u2019anshan, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26448","article-title":"Incidental parathyroidectomy during thyroidectomy increases the risk of postoperative hypocalcemia","volume":"127","author":"Lin","year":"2017","journal-title":"Laryngoscope"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.08.021","article-title":"Inadvertent parathyroidectomy during total thyroidectomy and central neck dissection for papillary thyroid carcinoma","volume":"161","author":"Sitges-Serra","year":"2017","journal-title":"Surgery"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-014-0209-y","article-title":"Hypocalcemia following thyroid surgery: incidence and risk factors. 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