Post-total thyroidectomy, a patient develops perioral tingling and positive Chvostek sign on day 1. Calcium is 7.2 mg/dL, phosphate is elevated. Which intraoperative event most likely caused this presentation?
- A Inadvertent parathyroidectomy or devascularization of all four glands ✓
- B Bilateral recurrent laryngeal nerve injury
- C Superior laryngeal nerve injury
- D Tracheal injury with subcutaneous emphysema
Correct answer: A. Inadvertent parathyroidectomy or devascularization of all four glands
Explanation
Transient or permanent hypoparathyroidism following total thyroidectomy results from inadvertent removal or devascularization of parathyroid glands; all four glands must be affected for significant hypocalcemia to manifest. The constellation of low calcium, elevated phosphate (hypoparathyroidism impairs phosphate excretion), and neuromuscular symptoms within 24-48 hours post-thyroidectomy is classic. Surgeons should routinely identify and preserve parathyroids, with autotransplantation to the sternocleidomastoid if viability is questionable.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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