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Hypocalcaemia after thyroidectomy — SCE Acute Medicine MCQ

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ModerateAcute Renal and Metabolic EmergenciesHypocalcaemia after thyroidectomySCE Acute Medicine

A 45-year-old woman is assessed on the acute medical unit. She develops perioral tingling and carpopedal spasm two days after thyroidectomy. Corrected calcium is 1.74 mmol/L and QT interval is prolonged. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Give intravenous calcium gluconate immediately

Give intravenous calcium gluconate immediately is the best answer because symptomatic hypocalcaemia with ECG changes requires intravenous calcium replacement. Start non-invasive ventilation on the acute unit is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Post-thyroidectomy hypoparathyroidism is a classic cause.

Reference: https://www.nice.org.uk/guidance#acute-medicine-order-46-1