A 45-year-old woman undergoes total thyroidectomy for a 2 cm papillary thyroid carcinoma. On postoperative day 1, serum calcium is 8.0 mg/dL and PTH is 12 pg/mL (normal 15-65 pg/mL). She is asymptomatic. What is the most appropriate management?

• A Oral calcium carbonate and calcitriol supplementation ✓
• B Intravenous calcium gluconate bolus
• C Observation with repeat calcium measurement
• D Re-exploration of the neck

Explanation

Post-thyroidectomy hypocalcaemia with low PTH indicates hypoparathyroidism. Asymptomatic patients with calcium 7.5-8.5 mg/dL and low PTH should receive oral calcium and calcitriol supplementation to prevent symptomatic hypocalcaemia. IV calcium is reserved for symptomatic patients or calcium below 7.5 mg/dL. Observation alone risks progression to symptomatic hypocalcaemia. Re-exploration is not indicated for hypoparathyroidism.

Reference: Schwartz's Principles of Surgery, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.