Hypoparathyroidism: The Daily PANCE Blueprint
A 28-year-old with a history of medullary thyroid cancer (s/p recent thyroidectomy) presents to your clinic complaining of muscle cramps and “tingling.” On physical exam, you notice twitching of the facial muscles when you percuss over the area of the facial nerve. What sign is this, and what lab abnormality would you expect to see, particularly in this patient?
A. Chvostek’s sign, hypercalcemia
B. Trousseau’s sign, hypocalcemia
C. Chvostek’s sign, hypocalcemia
D. Trousseau’s sign, hypercalcemia
E. None of the above
Answer and topic summary
The answer is C. Chvostek’s sign, hypocalcemia
Hypoparathyroidism is defined by low levels of parathyroid hormone (PTH) in the blood. It can be caused by injury to the parathyroid glands (during surgery or by an autoimmune disease), abnormal development of the parathyroids (congenital disorders like DiGeorge syndrome), infiltration of the parathyroid gland (hemochromatosis, Wilson disease, metastatic disease, etc), or impaired PTH action at the actual target organs. The most common cause overall is post-operative hypoparathyroidism secondary to thyroidectomy. Since the role of PTH is to help absorb calcium, patients will have symptoms of hypocalcemia, such as tetany, muscle cramps, seizures, and Chvostek or Trousseau sign. Chronic low levels of PTH can lead to bone issues, cataracts, and basal ganglia calcifications. Treatment includes managing the underlying etiology and calcium/vit D supplementation.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Endocrinology ⇒ ⇒
Also covered as part of the Internal Medicine EOR topic list
