Two hours after total thyroidectomy, a patient develops tingling around the mouth and carpopedal spasm. Serum calcium is 7.2 mg/dL. Which immediate intravenous agent should be given?

• A Magnesium sulfate
• B Calcium carbonate orally
• C Alfacalcidol alone
• D Calcium gluconate ✓

Explanation

Symptomatic hypocalcaemia after thyroidectomy, usually from inadvertent parathyroid removal or devascularisation, demands urgent intravenous calcium gluconate to correct tetany and prevent laryngeal stridor. Oral calcium and alfacalcidol are appropriate only for mild asymptomatic hypocalcaemia as maintenance therapy. Magnesium sulfate treats hypomagnesaemia-related hypocalcaemia but does not address post-surgical parathyroid insufficiency here.

Reference: Williams Textbook of Endocrinology, 14th ed.

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