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Which of the following is a potential complication of thyroidectomy?

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asked Apr 1 in General Surgery by Rajesh Bahara
A 30-year-old patient comes to the physician to explore the possibility of an endocrine disorder. Physical examination reveals a solitary thyroid nodule. Laboratory studies show an increased serum calcitonin level and a pentagastrin-induced rise in the secretion of calcitonin. A biopsy confirms the presence of a carcinoma. The patient is scheduled for a total thyroidectomy. Which of the following is a potential complication of this treatment?
(A) Acromegaly
(B) Cretinism
(C) Hypertension
(D) Hypoparathyroidism
(E) Renal osteodystrophy

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Answer: (D) Hypoparathyroidism
Hypoparathyroidism can occur if all of the parathyroid glands are accidentally removed during total thyroidectomy. Hypoparathyroidism can lead to hypocalcemia and hyperphosphatemia. Symptoms of hypocalcemia include tingling of the lips and digits and muscle spasms. Additionally, individuals with hypocalcemia have positive Chvostek’s sign (tapping of the facial nerve causes contraction of the facial muscles) and a positive Trousseau’s sign (occlusion of the brachial artery in the upper arm causes a carpal spasm).

Answer A is incorrect. Acromegaly is caused by an excess of growth hormone in adults after growth plates have already been fused. It is not a side effect of thyroidectomy.

Answer B is incorrect. Cretinism is the term used for fetal hypothyroidism. Cretinism can be caused by either a defect in thyroxine formation or failure of thyroid development. It is most common in iodine-deficient regions, and remains common in China. Typical physical findings are a pot-bellied, pale, and puffy-faced child with protruding umbilicus and protuberant tongue.

Answer C is incorrect. Hypertension can occur from a variety of mechanisms; however, thyroidectomy is not a cause.

Answer E is incorrect. Renal osteodystrophy occurs in patients with renal failure. The failing kidney retains phosphate, leading to hyperphosphatemia and subsequent hypocalcemia; hypocalcemia causes a secondary hyperparathyroidism, which is the basis for the bone pathology.
answered Apr 1 by Rajesh Bahara

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