Postoperative Hyperparathyroidism

Answer: b



Postoperative hypoparathyroidism commonly develops after total thyroidectomy for malignancy. Most patients undergoing operation on the thyroid experience some alteration in serum calcium. The hypocalcemia is usually transient and is not treated unless significant symptoms develop. The plasma calcium usually reaches its nadir at 48 to 72 hours after surgery and then slowly returns to normal over 2 to 3 days. For these reasons, careful postoperative monitoring of serum calcium levels is essential.

For acute symptomatic hypocalcemia, calcium should be administered intravenously. Usually 20 to 30 mL of 10% calcium gluconate is infused over a 15 to 20 minute period and then 50 to 100 mL are administered over the next 12 hours in adults. Calcium gluconate is less irritating to the veins than calcium chloride, and the calcium release is slower without the risk of overcorrection. Serum magnesium should always be measured and hypomagnesemia should be corrected if present. This is not the first priority for this patient. Symptoms should never be allowed to progress to the point demonstrated in this patient. Postoperative routines include careful monitoring of the serum calcium until stable. There is no evidence that this patient has a postoperative surgical problem such as a cervical hematoma. Laryngospasm and seizures are classical signs of hypocalcemia. Lastly, the likelihood of metastatic brain disease is very low in this circumstance.

Category: