A 45-year old female underwent thyroidectomy. On the 3rd day she developed
perioral numbness. Further investigation involves:
A. Free T3, T4
B. RAI Scan
C. Calcium, Phosphate and PTH levels
D. T3, T4, TSH
Answer. C
Solution. The next step in this situation should be to measure the calcium, phosphate, and
parathyroid hormone (PTH) levels. Perioral numbness can occur as a complication of
thyroidectomy, especially if the parathyroid glands, which regulate calcium levels in the body,
are accidentally removed or damaged during the procedure. The primary function of the
parathyroid glands is to regulate calcium levels, and if they are damaged or removed, the levels
of calcium, phosphate, and PTH in the blood can become abnormal. A measurement of the
calcium, phosphate, and PTH levels can help to determine if the patient has developed
hypoparathyroidism, which is a condition characterized by low levels of PTH and low levels of
calcium in the blood. If hypoparathyroidism is suspected, treatment may involve supplementing
with calcium and vitamin D to restore normal levels and relieve symptoms. Free T3 and T4, and
TSH levels would be measured to assess thyroid function, but in this case, it is unlikely that
thyroid function is the cause of the perioral numbness, and measuring the calcium, phosphate,
and PTH levels is a more appropriate next step. A RAI scan would be used to assess thyroid
function or to determine if there is residual or recurrent thyroid tissue present, but it is unlikely to
be helpful in this case where the focus is on calcium regulation and parathyroid function.