After surgery for hyperthyroidism (thyroidectomy), a patient develops facial twitching and carpopedal spasm. This is most likely due to:

1. A

   Hypocalcemia due to damage to parathyroid glands

2. B

   Hypercalcemia due to damage to parathyroid glands

3. C

   Hypernatremia

4. D

   Hyponatremia

Appeared in: NORCET 10 Mains

Explanation

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• The patient's symptoms of facial twitching and carpopedal spasm are hallmark signs of tetany.
• Tetany is caused by hypocalcemia (low serum calcium), which leads to increased neuromuscular excitability.
• A common and serious complication of thyroidectomy is accidental damage to or removal of the parathyroid glands, which are responsible for calcium regulation.
• Damage to the parathyroid glands results in decreased parathyroid hormone (PTH) secretion, causing a rapid drop in blood calcium levels and leading to the observed symptoms.

Why Other Options Were Wrong

• Option B: Hypercalcemia (high calcium) causes decreased neuromuscular excitability, leading to symptoms like muscle weakness, fatigue, and constipation, which are the opposite of tetany.
• Option C: Hypernatremia (high sodium) primarily causes neurological symptoms related to cellular dehydration, such as lethargy, intense thirst, confusion, and seizures. It does not cause the specific muscle spasms of tetany.
• Option D: Hyponatremia (low sodium) can cause neurological symptoms like headache, confusion, and seizures due to cerebral edema. However, it does not cause the characteristic carpopedal spasm and facial twitching seen in hypocalcemic tetany.

Related Visual

• Visual 1: Illustration - Demonstrating how to elicit Chvostek's sign by tapping on the facial nerve anterior to the ear, showing the resulting twitch of the facial muscles.
• Visual 2: Illustration - Showing the characteristic carpal spasm (Trousseau's sign) with wrist and metacarpophalangeal joint flexion, interphalangeal joint extension, and thumb adduction after inflating a blood pressure cuff.
• Visual 3: Anatomical Diagram - A posterior view of the thyroid gland, highlighting the location of the four small parathyroid glands to illustrate their proximity and risk of injury during thyroidectomy.

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Post-operative complications of thyroidectomy and associated electrolyte imbalances in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Monitoring for signs of hypocalcemia is a critical nursing responsibility after thyroid or parathyroid surgery. Early detection and treatment can prevent life-threatening complications like laryngeal spasm and seizures.
• Emergency equipment, including IV calcium gluconate and a tracheostomy set, must be kept at the bedside for any patient at high risk for post-thyroidectomy hypocalcemia.
• Patient education on the signs of hypocalcemia (tingling, numbness, muscle cramps) is vital for prompt reporting and intervention, both in the hospital and after discharge.

How to Approach the Question

• First, identify the key elements in the clinical scenario: the procedure (thyroidectomy) and the presenting symptoms (facial twitching, carpopedal spasm).
• Recognize that these symptoms are classic signs of tetany, which indicates increased neuromuscular excitability.
• Recall the major complications associated with a thyroidectomy. The most relevant one here is damage to the parathyroid glands.
• Connect the pathophysiology: The parathyroid glands regulate calcium. Damage to them disrupts calcium regulation.
• Evaluate the options based on this connection. Hypocalcemia (low calcium) causes tetany. Hypercalcemia, hypernatremia, and hyponatremia present with different clinical pictures.
• Select the option that correctly links the surgery, the affected glands, the resulting electrolyte imbalance, and the clinical signs.

Concept Tested & Keywords

• Concept Tested: Post-operative complications of thyroidectomy and associated electrolyte imbalances.
• Stem keywords: thyroidectomy, hyperthyroidism, facial twitching, carpopedal spasm
• Lead-in keywords: most likely due to
• Clinical cues: The combination of a specific surgery (thyroidectomy) with classic neurological signs (tetany) points directly to a predictable complication.

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