A 40-year-old male undergoes a total thyroidectomy for multinodular goiter. On postoperative day 1, he complains of tingling in his fingertips and perioral numbness. Tapping on the facial nerve anterior to the ear elicits ipsilateral twitching of the facial muscles (positive Chvostek's sign). What is the underlying cause?

Answer and explanation

Correct answer: D. Accidental devascularization or removal of the parathyroid glands causing hypocalcemia

  1. Step 1: Interpret clinical signs: Perioral numbness, paresthesias, and positive Chvostek's sign are hallmarks of neuromuscular irritability secondary to acute hypocalcemia.
  2. Step 2: Correlate with surgery: The parathyroid glands share a close anatomical relationship with the thyroid capsule; devascularization, trauma, or inadvertent excision during thyroidectomy causes transient or permanent hypoparathyroidism.
  3. Step 3: Conclude cause: Acute postsurgical hypocalcemia.
Answer
Accidental devascularization or removal of the parathyroid glands causing hypocalcemia.
Why not the others: Nerve injury changes the voice and does not cause perioral numbness; hypomagnesemia is not the usual cause on postoperative day 1; thyroid storm presents with fever, tachycardia and agitation rather than a positive Chvostek sign.

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