What is the management for whole body numbness after total thyroidectomy?

Management of Whole Body Numbness After Total Thyroidectomy

Whole body numbness after total thyroidectomy is most likely due to hypocalcemia from hypoparathyroidism, which requires immediate calcium supplementation and vitamin D administration for at least 10 days. 1

Etiology and Incidence

• Hypocalcemia is the most common early complication after total thyroidectomy, occurring in 20-30% of cases 1
• Temporary hypoparathyroidism occurs in 5.4-12% of patients, while permanent hypoparathyroidism affects 1.1-2.6% of patients 2
• Risk factors include extensive surgical dissection, especially with bilateral neck dissection for metastatic disease 2

Immediate Management

• Check serum calcium levels immediately to confirm hypocalcemia 2
• Administer calcium supplementation promptly:
  • For mild symptoms: Oral calcium carbonate 1-2g every 4-6 hours 1
  • For severe symptoms (tetany, perioral numbness, carpopedal spasm): IV calcium gluconate 10% solution (10-20ml) 1, 3
• Add vitamin D supplementation (calcitriol 0.25-0.5 mcg daily) to enhance calcium absorption 1
• Monitor calcium levels every 6-8 hours until stable 2

Monitoring and Follow-up

• Continue calcium plus vitamin D supplementation for at least 10 days 1
• Perform regular calcium level checks during the first 24-48 hours after surgery 2
• Watch for other signs of hypocalcemia:
  • Perioral numbness
  • Tingling in extremities
  • Muscle cramps
  • Carpopedal spasm
  • Laryngospasm (in severe cases) 3

Long-term Management

• For temporary hypoparathyroidism: Gradually taper calcium and vitamin D supplements over weeks to months as parathyroid function recovers 1, 4
• For permanent hypoparathyroidism: Lifelong calcium and vitamin D supplementation will be required 4, 5
• Target serum calcium levels in the low-normal range to avoid complications of hypercalcemia 5
• Regular monitoring of serum calcium, phosphate, and parathyroid hormone levels 5

Prevention Strategies

• Careful surgical technique to identify and preserve parathyroid glands during thyroidectomy 3, 6
• Autotransplantation of inadvertently removed parathyroid tissue into the sternocleidomastoid muscle 3
• Experienced surgeons have lower complication rates (4.3%) compared to less experienced surgeons (up to 17%) 7

Other Potential Complications to Monitor

• Recurrent laryngeal nerve injury (3-3.4% risk) causing voice changes 2
• Hematoma formation (0.45-4.2% risk) potentially leading to airway obstruction 7
  • If suspected, implement the SCOOP protocol: Skin exposure, Cut sutures, Open skin, Open muscles, Pack wound 7
• Wound infection 2

Patient Education and Follow-up

• Explain that temporary hypocalcemia is common and usually resolves within weeks to months 1
• Instruct patients to report worsening numbness, muscle cramps, or tetany immediately 3
• Schedule follow-up calcium level testing within 1-2 weeks of discharge 5
• Consider multidisciplinary approach involving endocrinology for complex cases 1