A 55-year-old woman undergoes total thyroidectomy for papillary thyroid carcinoma. On postoperative day 1, she develops perioral tingling and Chvostek's sign. Her corrected serum calcium is 6.8 mg/dL. What is the most likely cause?
- A Hypoparathyroidism due to parathyroid devascularization or removal ✓
- B Recurrent laryngeal nerve injury
- C Superior laryngeal nerve injury
- D Thyroid storm
Correct answer: A. Hypoparathyroidism due to parathyroid devascularization or removal
Explanation
Postoperative hypocalcemia following total thyroidectomy is most commonly caused by hypoparathyroidism resulting from inadvertent removal, devascularization, or thermal injury to the parathyroid glands. The parathyroid glands are at risk during thyroid surgery due to their close anatomical proximity. Symptomatic hypocalcemia (perioral tingling, Chvostek and Trousseau signs) with a corrected calcium below 8 mg/dL requires urgent calcium and vitamin D supplementation. This is the most common serious complication of 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.