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?
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.
10 mL of 10% magnesium sulfate intravenously
Oral vitamin D
100 mg oral Synthroid
Continuous infusion of calcium gluconate
Preoperative assessment and monitoring in anaesthesia