A 23-year-old woman undergoes total thyroidectomy for carcinoma of the thyroid gland. On the second postoperative day, she begins to complain of a tingling sensation in her hands. She appears quite anxious and later complains of muscle cramps. Which of the following is the most appropriate initial management strategy?
10 mL of 10% magnesium sulfate intravenously
Oral vitamin D
100 mg oral Synthroid
Continuous infusion of calcium gluconate
Intravenous calcium infusion is the treatment for severe, symptomatic hypocalcemia, although, typically, oral calcium supplementation (up to 1-2 g every 4 hours) is sufficient in patients with mild symptoms. Since postthyroidectomy hypocalcemia is usually due to transient ischemia of the parathyroid glands and is self-limited, in most cases the problem is resolved in several days. In cases of persistent hypocalcemia, vitamin D preparations may be necessary. There is no role for thyroid hormone replacement or magnesium sulfate in the treatment of hypocalcemia.
Preoperative assessment and monitoring in anaesthesia