Hypoparathyroidism: The Daily PANCE Blueprint
A 38-year-old woman is seen the day after a total thyroidectomy for papillary thyroid cancer. She reports tingling around her mouth and in her fingertips and has had muscle cramps in her hands. Her blood pressure is 118/74 mm Hg, and her pulse is 82/min. Which of the following findings would you most expect on examination?
A. Lid lag and a fine resting tremor
B. Decreased deep tendon reflexes
C. An upgoing plantar (Babinski) response
D. Muscle weakness that improves with repeated effort
E. Twitching of the facial muscles when the facial nerve is tapped in front of the ear
Answer and topic summary
The answer is E. Twitching of the facial muscles when the facial nerve is tapped in front of the ear
This is post-surgical hypoparathyroidism, the most common cause of acquired hypoparathyroidism. The parathyroid glands are removed or lose their blood supply during thyroid surgery, PTH falls, and calcium drops within 24 to 48 hours. Low calcium makes nerves hyperexcitable, causing perioral and fingertip tingling, cramps, and tetany. The expected finding is a Chvostek sign: tapping the facial nerve in front of the ear makes the facial muscles twitch. The Trousseau sign, carpal spasm after a blood pressure cuff is inflated above systolic pressure for 3 minutes, is more specific. Labs show low calcium, high phosphate, and a low or inappropriately normal PTH, and the ECG may show a prolonged QT. Check magnesium too. Treat severe or symptomatic hypocalcemia with IV calcium gluconate, then oral calcium and calcitriol. Hypocalcemia increases, not decreases, reflexes.
View blueprint lesson
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Endocrinology ⇒ ⇒
