A 35-year-old woman undergoes total thyroidectomy for papillary thyroid carcinoma. On post-operative day 1 she develops perioral tingling and a positive Chvostek's sign. Serum calcium is 7.2 mg/dL. What is the most appropriate immediate management?

• A Oral calcium carbonate 1 g TDS and reassurance as this is transient
• B Intravenous 10% calcium gluconate infusion followed by oral calcium and calcitriol ✓
• C Intravenous magnesium sulphate to facilitate PTH secretion
• D PTH assay followed by withholding any treatment until result is known

Explanation

Symptomatic hypocalcaemia following thyroidectomy (tetany, perioral tingling, positive Chvostek's/Trousseau's signs) requires immediate IV 10% calcium gluconate (10 mL over 10 minutes) to abort tetany, followed by a calcium gluconate infusion, then transition to oral calcium carbonate and calcitriol (active vitamin D). Oral calcium alone is insufficient for symptomatic hypocalcaemia. The mechanism is inadvertent parathyroid devascularisation or removal. Hypomagnesaemia may impair PTH response but is not the primary treatment here.

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

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Written and medically reviewed by the StethoPrep medical team.