A 35-year-old woman undergoes total thyroidectomy for papillary thyroid carcinoma (PTC). On post-operative day 1, she develops perioral tingling and positive Chvostek's sign. Her serum calcium is 7.2 mg/dL (normal 8.5–10.5 mg/dL). What is the most likely cause of her symptoms?
- A Hungry bone syndrome
- B Hypoparathyroidism from parathyroid gland devascularization ✓
- C Bilateral recurrent laryngeal nerve injury
- D Thyroid storm
Correct answer: B. Hypoparathyroidism from parathyroid gland devascularization
Explanation
Post-thyroidectomy hypocalcemia occurring on day 1 is most commonly due to inadvertent removal or devascularization of the parathyroid glands, leading to hypoparathyroidism and reduced PTH-mediated calcium resorption. Perioral tingling and a positive Chvostek's sign are classic manifestations of hypocalcemia. Hungry bone syndrome occurs in hyperparathyroid patients post-parathyroidectomy. Bilateral RLN injury causes laryngeal symptoms, not hypocalcemia.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.