Snap Shot A 33-year-old woman with a total thyroidectomy for papillary carcinoma of the thyroid, is noted to have carpal spasm when her blood pressure is taken and facial muscle contractions with tapping over the facial nerve. Introduction Most commonly caused by parathyroidectomy Also a complication of thyroid surgery Presentation Presents with tetany symptoms of hypocalcemia carpal tunnel spasm after blood pressure readings (Trousseau's Sign) Facial muscle contractions after tapping on the facial nerve (Chvostek's Sign) Evaluation Serum Ca Serum Phos PTH Common Cause Hyperparathyroidism ↑ ↓ ↑ adenoma Hypoparathyroidism ↓ ↑ ↓ parathyroidectomy Ectopic PTH ↑ ↓ ↓ malignancy Vit D malabsorption ↓ ↓ ↑ celiac disease, other GI isease hypo vit D with no phosphate excretion from the kidney. ↓ ↑ ↑ renal failure, pseudo hypoparathyroidism Treatment Give calcium gluconate Vitamin D supplement