Post-thyroidectomy Hypocalcemia: Clinical Presentation

Abstract

This chapter addresses in detail the symptoms and signs resulting from the effect of hypocalcemia on the different body systems and structures. Symptoms of hypocalcemia may be muscular, dermatological, and/or neuro-psychological. The typical “main d’accoucheur” posture is characterized by thumb adduction, flexion of metacarpo-phalangeal joints, extension of inter-phalangeal joints, and flexion of wrists. In pedal spasm, there is big toe extension and flexion of metatarso-phalangeal joints of the lateral four toes. These automatic muscle contractions are painful. All muscles can participate in tetany but the most dangerous is the spasm of laryngeal muscles. Signs of hypocalcemia may be neuro-muscular, cardiovascular, ophthalmological, and dermatological. Recovery of PTG function is also discussed in this chapter. Recovery is considered when parathyroid levels are above 10 pg/mL and the patients did not require daily calcitriol and calcium supplementation to avoid symptoms of hypocalcemia. Post-operative calcium values <8 mg/dL are considered as “biochemical hypocalcemia,” while the patients presenting paresthesia in the extremities and around the mouth, with positive Chvostek’s and Trousseau’s signs, are considered as “symptomatic hypocalcemia.”