A 42-year-old patient undergoes total thyroidectomy for papillary thyroid carcinoma. On day 1 post-operatively, serum calcium is 7.2 mg/dL with tingling in the fingertips. Chvostek's sign is positive. The most likely cause is:
- A Transient hypocalcemia from parathyroid ischaemia or devascularization ✓
- B Permanent hypoparathyroidism from gland removal
- C Hungry bone syndrome due to pre-existing hyperthyroidism
- D Hypomagnesemia inhibiting PTH secretion
Correct answer: A. Transient hypocalcemia from parathyroid ischaemia or devascularization
Explanation
Transient hypocalcemia due to inadvertent devascularization or bruising of the parathyroid glands is the most common cause of post-thyroidectomy hypocalcemia, occurring in up to 30% of cases. This is typically transient (days to weeks) as bruised glands recover. Permanent hypoparathyroidism (requiring lifelong supplementation) occurs in only 1–3% of total thyroidectomies. Hungry bone syndrome is more typical after parathyroidectomy for primary hyperparathyroidism.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.