A 34 year-old woman comes to the emergency department for evaluation and management of postsurgical hypoparathyroidism. Her serum calcium is 6.8 mg/dL (normal, 8.9 to 10.1 mg/dL) two days after undergoing subtotal thyroidectomy for a unicentric 2.5-cm right thyroid lobe papillary cancer, without evidence of metastatic lymph nodes. She tolerated her surgery without difficulty but developed mild symptoms of tingling paresthesias at her fingertips, toe tips, and lips, and muscle cramps, beginning about six hours after surgery. She was sent home on calcium carbonate 500 mg twice daily, but her tingling paresthesias worsened over the next 24 hours. Her laboratory studies during her emergency department evaluation showed her serum phosphate increased at 6.4 mg/dL (normal, 2.5 to 4.5 mg/dL), serum creatinine normal at 1.0 mg/dL, and parathyroid hormone (PTH) undetectable.
Bone/Parathyroid Case 1