A 55-year-old man undergoes total thyroidectomy. Two days postoperatively, he develops circumoral tingling, positive Chvostek's sign, carpopedal spasm, and prolonged QT interval on ECG. Serum calcium is 6.8 mg/dL. What is the most likely cause and appropriate immediate treatment?
- A Recurrent laryngeal nerve palsy; voice therapy
- B Hypoparathyroidism from parathyroid gland removal; intravenous calcium gluconate ✓
- C Hypothyroidism; levothyroxine replacement
- D Superior laryngeal nerve palsy; observation
Correct answer: B. Hypoparathyroidism from parathyroid gland removal; intravenous calcium gluconate
Explanation
Post-thyroidectomy hypocalcaemia results from inadvertent removal or devascularisation of the parathyroid glands, causing hypoparathyroidism. Signs of hypocalcaemia include Chvostek's sign (facial muscle twitch on tapping over the facial nerve), Trousseau's sign (carpopedal spasm), perioral tingling, and prolonged QT. Symptomatic hypocalcaemia requires immediate IV calcium gluconate (10 mL of 10% solution) followed by oral calcium and calcitriol supplementation. It is the most common serious complication after total thyroidectomy.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.