Teriparatide for Postsurgical Hypoparathyroidism

This study will evaluate the effects of teriparatide (synthetic parathyroid hormone, brand
name Forteo) on low calcium levels in the setting of thyroid surgery associated with low
parathyroid hormone.

Inclusion criteria:

- Patients post bilateral thyroid bed surgery (cancer, Graves' disease, multinodular
goiter)

- Symptomatic hypocalcemia

- Total calcium < 8 mg/dL persisting after 24 hours of therapy with calcitriol (minimum
0.25 mcg twice a day) and calcium supplementation (minimum 1.5 grams of elemental
calcium per day)

- Parathyroid hormone (PTH) level below low end of normal range

Exclusion criteria:

- Renal failure

- Any prior parathyroid pathology

- Pre-existing hypercalcemia

- Metabolic bone diseases other than osteoporosis

- Paget's disease

- Ongoing therapy with Forteo for osteoporosis

- Active non-thyroidal malignancy or suspicion of residual thyroid malignancy

- History of skeletal malignancies, primary or metastatic

- Pregnancy

- Active or recent urolithiasis

- Digitalis therapy

- Patients at increased baseline risk for osteosarcoma, i.e. family history of
osteosarcoma or prior radiation therapy involving the skeleton

- Pediatric populations

- Unexplained elevations of alkaline phosphatase