A 38-year-old woman undergoes total thyroidectomy for papillary thyroid carcinoma. Post-operatively she develops perioral numbness, tingling of fingertips, and positive Chvostek's sign on day 1. Serum calcium is 7.2 mg/dL (corrected). The MOST likely cause is:

• A Permanent hypoparathyroidism due to parathyroid gland excision
• B Transient hypoparathyroidism due to devascularisation of the parathyroid glands ✓
• C Recurrent laryngeal nerve injury causing stridor and secondary hypoxia
• D Hungry bone syndrome from pre-existing hyperthyroidism

Explanation

Transient hypocalcaemia occurs in up to 30% of patients after total thyroidectomy due to bruising or devascularisation of the parathyroid glands, which typically recover function within days to weeks. Permanent hypoparathyroidism is defined as persisting beyond 6–12 months and occurs in <3% of experienced surgeons' series. Recurrent laryngeal nerve injury causes hoarseness/stridor, not hypocalcaemia. Hungry bone syndrome occurs after parathyroidectomy for hyperparathyroidism, not routine thyroid surgery.

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

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Written and medically reviewed by the StethoPrep medical team.