Accidental removal of parathyroid gland during thyroidectomy cause?

VSSC Nursing Officer - 2021

Medical & Surgical Nursing

Hard

Appeared in: VSSC Nursing Officer - 2021

Explanation

The parathyroid glands secrete parathyroid hormone (PTH), which is the primary regulator of serum calcium levels.
Accidental surgical removal of these glands during a thyroidectomy leads to hypoparathyroidism, a state of deficient PTH secretion.
Without sufficient PTH, serum calcium levels fall (hypocalcemia).
Hypocalcemia increases the excitability of nerve and muscle cells, leading to involuntary muscle contractions known as tetany.
Tetany is the hallmark clinical manifestation of acute hypocalcemia.

Option B: Adrenocortical stimulation involves the adrenal glands, which are located on top of the kidneys and regulate stress response and metabolism through hormones like cortisol and aldosterone. This process is anatomically and physiologically separate from the parathyroid glands and calcium homeostasis.
Option C: Myxoedema is a sign of severe, long-standing hypothyroidism (low thyroid hormone levels). While the thyroid gland is the site of the surgery, myxoedema is caused by a deficiency of thyroid hormones (T3/T4), not parathyroid hormone.
Option D: Hypovolemia is a state of decreased blood volume. While it can be a complication of any surgery due to hemorrhage, it is not the specific metabolic or endocrine consequence of removing the parathyroid glands.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Thyroidectomy as background academic context rather than a clinical decision trigger.
Post-thyroidectomy, nurses must prioritize monitoring for signs of hypocalcemia. This includes assessing for numbness/tingling, muscle twitching, and checking for Chvostek's and Trousseau's signs.
Emergency equipment, including IV calcium gluconate and a tracheostomy tray, must be readily available at the bedside due to the risk of laryngospasm, a life-threatening complication of severe hypocalcemia.
Patient education is crucial. The patient and family should be taught to recognize and report symptoms of hypocalcemia immediately, both in the hospital and after discharge.

How to Approach the Question

First, identify the key elements of the question: 'accidental removal', 'parathyroid gland', and 'thyroidectomy'.
Recall the primary function of the parathyroid gland, which is to regulate calcium levels through parathyroid hormone (PTH).
Reason that removal of the gland would lead to a deficiency of its hormone (hypoparathyroidism) and a subsequent drop in blood calcium (hypocalcemia).
Connect the physiological effect of low calcium to its clinical signs. Low calcium increases neuromuscular excitability.
Evaluate the options. 'Tetany' is the medical term for the state of neuromuscular hyperexcitability and muscle spasms caused by hypocalcemia.
Eliminate the other options by identifying their distinct pathophysiology (adrenal function, thyroid function, blood volume), which are unrelated to the direct effect of parathyroid removal.

Concept Tested & Keywords

Qw4sGI33kE0KscXbn9l7yh

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 pp. 30-32, 29-31

E6 Physiology Essentials Sembulingam 10e Part 2 p. 51-53