Medical Surgical Thyroid #5

Question

The nurse is caring for a client who underwent thyroidectomy with removal of parathyroid tissue following a diagnosis of thyroid cancer. The nurse notices twitches and spasms along the left lateral facial region. The nurse suspects which adverse outcome of the surgery?

Answers

  1. Hypercalcemia
    • Rationale:

      This answer is not correct because hypocalcemia, not hypercalcemia, is associated with thyroidectomy and removal of the parathyroid gland. Since the parathyroid glands produce parathyroid hormone, if that hormone is decreased in the bloodstream, so will calcium. Symptoms of hypocalcemia include a positive Chvostek’s sign or Trousseau’s sign, twitches, spasms, muscle weakness, muscular cramping, fatigue, tingling feeling, confusion, and irritability.

  2. Hyperkalemia
    • Rationale:

      This answer is not correct because there is no reason for hyperkalemia to occur related to a thyroidectomy and removal of the parathyroid gland. Parathyroid glands produce parathyroid hormone, if that hormone is decreased in the bloodstream, so will calcium. Symptoms of hypocalcemia include a positive Chvostek’s sign or Trousseau’s sign, twitches, spasms, muscle weakness, muscular cramping, fatigue, tingling feeling, confusion, and irritability.

  3. Hypocalcemia
    • Rationale:

      This answer is correct because since the parathyroid glands produce parathyroid hormone, if that hormone is decreased in the bloodstream, so will calcium. Decreased calcium in the body is called hypocalcemia and is defined as serum calcium < 8.8 mg/dL. Symptoms of hypocalcemia include a positive Chvostek’s sign or Trousseau’s sign, twitches, spasms, muscle weakness, muscular cramping, fatigue, tingling feeling, confusion, and irritability. Treatment is administration of oral or IV calcium, depending on the severity of symptoms.

  4. Spread of cancer to mandibular glands
    • Rationale:

      This answer is not correct because twitches and spasms along the left lateral facial region indicate hypocalcemia, not spread of cancer to mandibular glands. Symptoms of hypocalcemia include a positive Chvostek’s sign or Trousseau’s sign, twitches, spasms, muscle weakness, muscular cramping, fatigue, tingling feeling, confusion, and irritability.

Overview

The parathyroid glands control the amount of calcium in the body. If removed, this can cause hypocalcemia in the client.

Explanation

Learning Outcomes

The parathyroid glands are on the thyroid gland and will be removed if a client has a total thyroidectomy. Since the parathyroid glands produce parathyroid hormone, if that hormone is decreased in the bloodstream, so will calcium. Decreased calcium in the body is called hypocalcemia and is defined as serum calcium < 8.8 mg/dL. Symptoms of hypocalcemia include a positive Chvostek’s sign or Trousseau’s sign, twitches, spasms, muscle weakness, muscular cramping, fatigue, tingling feeling, confusion, and irritability. Treatment is administration of oral or IV calcium, depending on the severity of symptoms.

Test Taking Tip

A way to remember how calcium affects the body is to think about how many years ago people would drink warm milk at night to help them relax and sleep. If you think about the calcium in milk doing that, then too much calcium makes you too relaxed (hypercalcemia) and not enough can cause you to be not relaxed or stimulated. So then lack of calcium or hypocalcemia can cause twitching, tetany, spasms, and cramping.

Video Rationale