After thyroidectomy, a patient develops tingling, muscle cramps, and facial twitching; which lab abnormality is likely and what is the urgent treatment?

• A. Hypercalcemia; treat with IV bisphosphonates.
• B. Hyperkalemia; treat with IV calcium gluconate.
• C. Hypocalcemia; treat with oral calcium carbonate.
• D. Hypocalcemia; treat with IV calcium gluconate.

Answer: (D)

Damage to or removal of the parathyroid glands during thyroidectomy can lead to hypoparathyroidism, which causes hypocalcemia. Low calcium makes nerves and muscles hyperexcitable, producing tingling around the mouth, muscle cramps, and facial twitching—the classic signs of acute hypocalcemic tetany. You’d expect a low serum calcium (often with low PTH and high phosphate) in this scenario. The urgent treatment is intravenous calcium gluconate to rapidly raise calcium levels and stabilize cell membranes, which quickly relieves the symptoms and reduces risk of more severe issues. Once stabilized, you can continue with calcium supplementation and consider calcitriol as needed, with careful electrolyte monitoring.