Management of hypocalcemia after modified bilateral radical neck dissection followed with total thyroidectomy: a case report

I Made Arimbawa; Ayu Diah Perdana Paramita; I Gde Ardika Nuaba; Herman Saputra

doi:10.29332/ijhs.v5n1.654

Authors

I Made Arimbawa
de_awae@yahoo.com
Department of Child Health, Medical Faculty, Udayana University, Indonesia
Ayu Diah Perdana Paramita Department of Child Health, Medical Faculty, Udayana University, Indonesia
I Gde Ardika Nuaba Department of Ear, Nose, Throat-Head and Neck Surgery, Medical Faculty, Udayana University, Indonesia
Herman Saputra Department of Pathological Anatomy, Medical Faculty, Udayana University, Indonesia

Keywords:

calcitriol, calcium, hypocalcemia, hypoparathyroidism, hypovitaminosis

Abstract

Hypocalcemia is a common complication after total thyroidectomy due to acute hypoparathyroidism post-surgery. The incident varies from 7%-69% depends on the surgery center. The management is divided based on the onset and symptoms. Carpal-pedal spasm, seizure, bronchospasms are the emergency symptoms of hypocalcemia that require administration of intravenous calcium. However, the management of asymptomatic hypocalcemia with oral calcium, vitamin D, and hydrochlorothiazide can be difficult due to wide fluctuations of serum calcium and the risks of complication. Hereby we report a 14-year-old girl with hypocalcemia due to hypoparathyroidism post modified bilateral radical neck dissection and total thyroidectomy. She had papillary thyroid carcinoma and lymph node metastases. After surgery, she developed classic signs of hypocalcemia, numbness in extremities which progressed to cramps. Physical examination revealed chvostek’s sign. Laboratory examination showed the critical value of hypocalcemia with a normal level of albumin, hypoparathyroidism, and hypovitaminosis D. The initial treatment was started by giving intravenous calcium gluconate 10% and calcitriol. Monitoring levels of calcium and phosphate were performed regularly. Calcium level was maintained by giving a high dose of elemental calcium, vitamin D3 and hydrochlorothiazide followed.

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