A 45-year-old woman undergoes total thyroidectomy for papillary thyroid carcinoma (3 cm, unilateral). Postoperatively she develops tingling in the fingers and toes, positive Chvostek and Trousseau signs. Serum calcium is 7.1 mg/dL and iPTH is <5 pg/mL. The most appropriate first-line management is:

• A Oral calcium carbonate 500 mg TDS
• B IV calcium gluconate 10 mL of 10% over 10 minutes, then oral calcium + calcitriol ✓
• C Intramuscular PTH analogue injection
• D Calcium-rich diet and monitoring for 48 hours

Explanation

Symptomatic hypocalcemia post-thyroidectomy due to hypoparathyroidism (iPTH <15 pg/mL) with neuromuscular signs (positive Chvostek, Trousseau) requires immediate IV calcium gluconate to prevent laryngospasm/tetany, followed by oral calcium (1–2 g/day elemental) combined with calcitriol (active vitamin D, 0.25–0.5 mcg BD) to compensate for absent PTH-mediated 1-alpha hydroxylation. Oral calcium alone is insufficient for symptomatic cases.

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.