A 35-year-old woman undergoes total thyroidectomy for papillary thyroid carcinoma (T2N0M0). Intraoperatively, the recurrent laryngeal nerve (RLN) is identified and preserved. On postoperative day 1, she is found to have a serum calcium of 7.4 mg/dL and complains of perioral numbness. Which statement best describes the pathophysiology of her complication?

• A Inadvertent removal of all parathyroid glands causing permanent hypoparathyroidism
• B Devascularization or inadvertent removal of parathyroid glands causing transient hypoparathyroidism ✓
• C Hungry bone syndrome due to rapid normalization of thyroid hormone levels
• D Dilutional hyponatremia due to excessive IV fluid administration

Explanation

Post-thyroidectomy hypocalcemia most commonly results from devascularization, bruising, or inadvertent removal of parathyroid glands. In the early postoperative period (within 24-48 hours), this is usually transient as parathyroid function recovers. The inferior parathyroid glands are most at risk, particularly with the inferior thyroid artery ligation. Hungry bone syndrome occurs after parathyroidectomy for hyperparathyroidism, not thyroidectomy. Permanent hypoparathyroidism (requiring lifelong calcium/vitamin D) affects <2% of patients after total thyroidectomy.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.