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Post-thyroidectomy hypocalcaemia — SCE Endocrinology MCQ

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HardCalcium/BonePost-thyroidectomy hypocalcaemiaSCE Endocrinology

A 31-year-old woman develops painful carpopedal spasm 24 hours after total thyroidectomy. Calcium is 1.78 mmol/L, phosphate is 1.8 mmol/L, magnesium is 0.74 mmol/L and PTH is low. ECG shows QT prolongation. What is the most appropriate management?

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Correct answer: D — Intravenous calcium gluconate with active vitamin D and oral calcium replacement

Intravenous calcium gluconate with active vitamin D and oral calcium replacement is best because symptomatic acute hypocalcaemia after thyroidectomy with low PTH needs intravenous calcium and active vitamin D replacement. The alternatives are less appropriate because furosemide, cinacalcet and bisphosphonates worsen hypocalcaemia; dietary calcium restriction is unsafe with tetany and QT prolongation. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: Society for Endocrinology hypocalcaemia emergency guidance