A 45-year-old patient undergoes total thyroidectomy for papillary thyroid carcinoma. Post-operatively she develops perioral tingling, positive Chvostek's sign, and albumin-corrected calcium of 7.2 mg/dL. The most common underlying mechanism of this complication is:

• A Thermal injury to all parathyroids during energy device use
• B Hungry bone syndrome due to pre-operative hyperthyroidism
• C Inadvertent excision of parathyroid glands mistaken for lymph nodes
• D Devascularization of all four parathyroid glands due to ligation of superior thyroid artery branches ✓

Explanation

Post-thyroidectomy hypoparathyroidism most commonly results from devascularization of the parathyroid glands, particularly during dissection near the superior thyroid artery where the superior parathyroids derive their blood supply, and during central compartment dissection affecting the inferior parathyroids. Inadvertent excision is a lesser contributor. The recurrent laryngeal nerve and parathyroid vasculature are the critical structures at risk. Autotransplantation of devascularized parathyroid tissue into the sternocleidomastoid muscle helps preserve function.

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

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Written and medically reviewed by the StethoPrep medical team.