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A 39-year-old woman who recently underwent thyroidectomy for Grave's disease

complains of anxiety, muscle cramps, and poor sleep. Her medications include daily
multivitamin supplements and lansoprazole for acid reflux disease. Her temperature is
36.6 C (98 F), blood pressure is 142/85 mm Hg, and pulse is 82/min. Electrocardiogram
shows normal sinus rhythm with prolongation of the corrected QT interval to 510 msec
(normal <460 msec). Which of the following is the most likely diagnosis?

o A. Hyperkalemia
0 B.. Hypocalcemia
o C. Hyponatremia
D. Persistent hyperthyroidism
0

E. Vitamin D toxicity
0

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Item: ~?Mark <? C> S ~ ~ , ~
Q. ld : 8882 Prevoous Next Lab Values Notes Calculator Reverse Color Text Zoom

A 39-year-old woman who recently underwent thyroidectomy for Grave's disease

complains of anxiety, muscle cramps, and poor sleep. Her medications include daily
multivitamin supplements and lansoprazole for acid reflux disease. Her temperature is
36.6 C (98 F), blood pressure is 142/85 mm Hg, and pulse is 82/min. Electrocardiogram
shows normal sinus rhythm with prolongation of the corrected QT interval to 510 msec
(normal <460 msec). Which of the following is the most likely diagnosis?

A Hyperkalemia [9%]
B. Hypocalcemia [85%)
C. Hyponatremia [1%)
D. Persistent hyperthyroidism [3%)
E. Vitamin D toxicity [2%)

- ,
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Explanation: User
Post-surgical hypoparathyroidism can occur during thyroidectomy or from the removal of
3 1/2 parathyroid glands due to parathyroid hyperplasia. Hypocalcemia is the resultant
condition of the hypoparathyroidism and the most common complication of
thyroidectomy. Patients with hypocalcemia can be asymptomatic at initial presentation
(found incidentally) or may complain only of nonspecific symptoms (eg, fatigue, anxiety,
depression). Involuntary contractions (tetany) involving the lips, face, and extremities
and seizures are seen in severe hypocalcemia. Electrocardiogram may show QT-interval
prolongation.

(Choice A) Hyperkalemia is not a common postoperative complication of thyroidectomy.

(Choices C and 0) Persistent hypothyroidism (not hyper) can be seen
post-thyroidectomy and can cause hyponatremia without thyroid hormone
supplementation. Prolonged QT interval is not seen with hypothyroidism/hyponatremia.
(Choice E) Vitamin D toxicity is associated with hypercalcemia, which results in
shortened QT interval.

Educational objective:
Hypoparathyroidism (parathyroid hormone deficiency) is characterized by low calcium
and elevated phosphorus levels in the presence of normal renal function. Causes of
hypoparathyroidism include post surgical, autoimmune parathyroid destruction, and
defective calcium-sensing receptor. Hypocalcemia is the most common complication
Item: ~?Mark <? C> S ~ ~ , ~
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' A. Hyperkalemia [9%]

v B. Hypocalcemia [85%]
C. Hyponatremia [1 %]
D. Persistent hyperthyroidism [3%]
' E. Vitamin D toxicity [2%]

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Explanation: User
Post-surgical hypoparathyroidism can occur during thyroidectomy or from the removal of
3 1/2 parathyroid glands due to parathyroid hyperplasia. Hypocalcemia is the resultant
condition of the hypoparathyroidism and the most common complication of
thyroidectomy. Patients with hypocalcemia can be asymptomatic at initial presentation
(found incidentally) or may complain only of nonspecific symptoms (eg, fatigue, anxiety,
depression). Involuntary contractions (tetany) involving the lips, face, and extremities
and seizures are seen in severe hypocalcemia. Electrocardiogram may show QT -interval
prolongation.
(Choice A) Hyperkalemia is not a common postoperative complication of thyroidectomy.
(Choices C and 0) Persistent hypothyroidism (not hyper) can be seen
post-thyroidectomy and can cause hyponatremia without thyroid hormone
supplementation. Prolonged QT interval is not seen with hypothyroidism/hyponatremia.
(Choice E) Vitamin D toxicity is associated with hypercalcemia, which results in
shortened QT interval.
Educational objective:
Hypoparathyroidism (parathyroid hormone deficiency) is characterized by low calcium
and elevated phosphorus levels in the presence of normal renal function. Causes of
hypoparathyroidism include post surgical, autoimmune parathyroid destruction, and
defective calcium-sensing receptor. Hypocalcemia is the most common complication
seen post thyroidectomy.

References:
1. Prognostic significance of intraoperative PTH test for the development
of post-thyroidectomy hypocalcaemia.

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