A 45-year-old undergoes total thyroidectomy for papillary thyroid cancer. On postoperative day 2, serum calcium is 7.1 mg/dL with perioral tingling. Chvostek sign is positive. Serum PTH returns at 4 pg/mL (normal 10–65). Which management is most appropriate?

• A Reassurance and repeat calcium in 24 hours
• B IV calcium gluconate bolus followed by continuous infusion titrated to serum calcium
• C Oral calcium carbonate 1–2 g every 6 hours with active vitamin D (calcitriol) ✓
• D IV magnesium sulfate infusion

Explanation

This patient has symptomatic hypoparathyroidism post-thyroidectomy with low PTH and calcium, but symptoms are mild (perioral tingling, positive Chvostek) without severe manifestations such as tetany or QT prolongation. The standard first-line treatment is oral calcium supplementation combined with calcitriol (active vitamin D, 1,25-dihydroxycholecalciferol) since PTH-dependent renal activation of vitamin D is absent. IV calcium is reserved for symptomatic hypocalcemia with tetany, seizures, or laryngospasm. IV magnesium is indicated when hypomagnesemia causes resistant hypoparathyroidism.

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.