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Hypoparathyroidism — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesHypoparathyroidismRACP Adult Medicine

A 32-year-old woman with a history of Graves' disease treated with total thyroidectomy 5 years ago presents with sudden onset perioral tingling and carpopedal spasm. She has not been taking any medications. Her calcium is 1.60 mmol/L and phosphate is 2.1 mmol/L. PTH is undetectable. What is the most appropriate acute treatment?

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Correct answer: E — IV calcium gluconate 10% – 10 mL over 10 minutes

Symptomatic hypocalcaemia with tetany requires urgent IV calcium gluconate (10 mL of 10% solution = 2.2 mmol calcium) given slowly over 10 minutes with cardiac monitoring. Calcium chloride is an alternative via central line but causes tissue necrosis if extravasated. The undetectable PTH with high phosphate confirms post-surgical hypoparathyroidism. Maintenance therapy includes calcitriol and oral calcium supplementation.

Reference: eTG – 2025 – Endocrinology; AMH – 2025 – Calcium supplements