Single most likely diagnosis:
- Hypocalcemia: This condition is the most likely cause of perioral numbness and tingling in a post-thyroidectomy patient. The symptoms are due to the accidental removal or damage to the parathyroid glands during surgery, leading to hypoparathyroidism and subsequently low calcium levels.
Other Likely diagnoses:
- Anxiety or stress response: The patient may be experiencing anxiety or a stress response to the surgery, which can manifest as numbness or tingling sensations.
- Medication side effects: Certain medications used in the perioperative period can cause numbness or tingling as a side effect.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Airway compromise: Although the patient's oxygen saturation is normal, any signs of respiratory distress or airway compromise must be promptly addressed, as this can be life-threatening.
- Stroke or transient ischemic attack (TIA): Although less likely, new-onset numbness or tingling can be a symptom of a stroke or TIA, especially in an elderly patient.
Rare diagnoses:
- Neuropathy: Direct injury to the nerves during surgery is a rare but possible cause of perioral numbness and tingling.
- Hypomagnesemia: Low magnesium levels can cause similar symptoms to hypocalcemia and may occur post-operatively, especially if the patient has received certain medications or has underlying conditions affecting magnesium levels.