A 52-year-old patient undergoes total thyroidectomy for papillary thyroid carcinoma. On postoperative day 1, she develops perioral numbness and carpopedal spasm. Serum calcium is 6.8 mg/dL. Chvostek's sign is positive. The most likely explanation for this complication and the immediate treatment is:
- A Hypoparathyroidism due to inadvertent parathyroid devascularisation; IV calcium gluconate followed by calcitriol ✓
- B Bilateral recurrent laryngeal nerve (RLN) injury; IV calcium gluconate
- C Thyroid storm; IV propranolol and PTU
- D Hungry bone syndrome; high-dose oral calcium only
Correct answer: A. Hypoparathyroidism due to inadvertent parathyroid devascularisation; IV calcium gluconate followed by calcitriol
Explanation
Post-thyroidectomy hypocalcaemia (symptomatic tetany, Chvostek's sign, serum Ca <8 mg/dL) most commonly results from devascularisation or inadvertent removal of parathyroid glands, causing transient or permanent hypoparathyroidism. Immediate management is IV 10% calcium gluconate (10 mL over 10 min) followed by oral calcium and calcitriol. RLN injury causes dysphonia, not hypocalcaemia. Hungry bone syndrome occurs after parathyroidectomy, not thyroidectomy in this context.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.