On the second postoperative day after total thyroidectomy, a woman develops perioral tingling and a positive Chvostek sign. Serum calcium is 6.8 mg/dL, phosphate is 5.9 mg/dL, and intact PTH is undetectable. She is asymptomatic apart from tingling. The most appropriate immediate treatment is:

• A Oral calcium carbonate with active vitamin D
• B Intravenous phosphate binder
• C Intravenous calcium gluconate ✓
• D Recombinant human PTH injection

Explanation

Transient hypoparathyroidism from surgical devascularisation of the parathyroids is the classic cause of early post-thyroidectomy hypocalcaemia, confirmed here by undetectable PTH with hyperphosphataemia. Symptomatic hypocalcaemia with neuromuscular irritability requires intravenous calcium gluconate under ECG monitoring. Oral calcium plus calcitriol is appropriate for mild asymptomatic cases. Recombinant PTH (Natpara) is not standard acute therapy in India and is reserved for refractory chronic cases.

Reference: Williams Textbook of Endocrinology, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.