Hypocalcemia as an important differential diagnosis in patie
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It is essential to consider hypocalcemia as a cause of stridor, especially following postoperative thyroidectomy, as hypocalcemia secondary to hypoparathyroidism is an important differential diagnosis. Advances in intraoperative technology to optimize the vascularization of the parathyroid glands can help to predict and prevent patients from a postoperative hypoparathyroidism.

An adult patient underwent a total thyroidectomy for struma multinodosa at our hospital. During surgery, one parathyroid gland has been re-implanted into the left lateral throat muscle.

On the first postoperative day, the patient complained about general discomfort, paresthesia, nausea, and dizziness at mobilization. The calcium blood level was 1.73 mmol/L, and parathyroid hormone was 17.4 pg/mL. We initiated a calcium substitution with 1 g calcium and 0.5 µg Vitamin D per day, under which the paresthesia reduced.

On the second postoperative day, the patient suddenly suffered from severe paresthesia at the entire body with dyspnea and stridor—and subjectively described a laryngospasm.

Besides the laryngeal stridor, a positive Trousseau sign was noted within our clinical examination. The postoperative laboratory results showed a decrease of the calcium blood levels with a hypocalcemia of 1.68 mmol/L. The blood oxygenation level was 94% with 2l of oxygen flow, the blood pressure 160/85 mm Hg and the pulse 75/min.

A postoperative laryngoscopy had previously shown a good function of both vocal cords. Furthermore, a postoperative hematoma could be excluded by using sonography, and there was no suggestion of allergic reactions. A hypocalcemia due to postoperative primary hypoparathyroidism therefore seemed to be the explanation for the patient's laryngospasm and stridor.

Considering hypocalcemia the cause of stridor and laryngospasm, an intravenous infusion of 20 mL calcium gluconate 10% (which is equivalent to 184 mg calcium) was immediately given within four hours, while electrolyte blood levels and the patient were monitored.

The intravenous calcium substitution with 20 mL calcium gluconate 10% completely reversed all symptoms: the laryngospasm and stridor disappeared, the pulmonary auscultation was normal and the blood oxygenation level reached 99% without oxygen substitution. Additionally, the nausea and dizziness, which were present since the first operative day, disappeared after calcium substitution.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3559?af=R
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