A 40-year-old woman undergoes total thyroidectomy. On the second postoperative day, she develops perioral tingling and carpo-pedal spasm. Serum calcium is 6.8 mg/dL. Which of the following indicates permanent hypoparathyroidism rather than transient hypocalcemia?

• A Symptoms persisting beyond 24 hours
• B Serum PTH undetectable at 24 hours postoperatively
• C Requirement for calcium supplementation for more than 6 months ✓
• D Chvostek sign positivity on examination

Explanation

Permanent hypoparathyroidism is defined as the need for calcium and/or vitamin D supplementation beyond 6 months postoperatively; transient hypoparathyroidism resolves within this period. While undetectable PTH at 24 hours can predict those at higher risk, it does not define permanency by itself since PTH may recover. Chvostek sign is a clinical sign of hypocalcemia, not specific for permanency.

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

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