A patient with a 2.5 cm papillary thyroid microcarcinoma (actually >1 cm, classified T1b) undergoes total thyroidectomy. Post-operatively, serum PTH drawn at 6 hours is 8 pg/mL (normal 15–65). What is the most likely complication and anticipated clinical course?

• A Permanent hypoparathyroidism; lifelong calcium and calcitriol replacement required
• B Hungry bone syndrome; resolves with IV magnesium
• C Superior laryngeal nerve injury; no treatment needed
• D Transient hypoparathyroidism; recovery expected within 6–12 months ✓

Explanation

A PTH < 10 pg/mL at 6 hours post-thyroidectomy is highly predictive of post-operative hypocalcemia due to parathyroid dysfunction. Most cases are transient, occurring due to devascularization or stunning of parathyroid glands during surgery, and recover within weeks to 6–12 months. Permanent hypoparathyroidism (persisting > 12 months) is less common, occurring in about 2–3% of total thyroidectomies. Hungry bone syndrome occurs after parathyroidectomy for primary hyperparathyroidism, not thyroidectomy. PTH-guided early discharge and prophylactic calcium/calcitriol are now standard in enhanced recovery protocols.

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

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Written and medically reviewed by the StethoPrep medical team.