Transient hypocalcemia is common in the first 24 hours after total thyroidectomy, occurring in about 60-90% of patients. Monitoring postoperative serum calcium and aggressively repleting calcium, either orally or intravenously, avoids complications of hypocalcemia.
Laryngospasm causing inspiratory stridor after thyroidectomy is a medical emergency. The timing of stridor after thyroidectomy can provide a clue to its cause. If respiratory distress or stridor is apparent immediately upon extubation, bilateral recurrent laryngeal nerve injury is likely (Choice B). Stridor appearing within a few hours of surgery suggests possible wound hematoma with tracheal compression (Choice E). Prompt removal of bandages and examination of the wound for swelling should be performed. Stridor appearing later, especially if preceded by paresthesias or muscle cramps, suggests hypocalcemia from transient hypoparathyroidism or inadvertent parathyroidectomy.