QuestionSBA
QuestionChoice
Yes, this is the correct answer. The patient has had a partial thyroidectomy, which essentially means partial removal of the thyroid gland. As the parathyroid glands are located on the posterior aspect of the thyroid gland, it is possible for them to be damaged iatrogenically during thyroid surgery. As the parathyroid glands secrete PTH into the bloodstream, the patient will have a reduced serum PTH concentration. PTH is responsible for the activation of osteoclasts to resorb bone and secrete calcium into the bloodstream. Hence if there is a deficiency of PTH, there will be a reduced calcium ion concentration and the patient will be experiencing symptoms of hypocalcaemia.
10007835
a
Hypoparathyroidism secondary to iatrogenic damage to the parathyroid glands during the partial thyroidectomy
QuestionChoice
No, this is not the correct answer. Whilst chronic kidney disease can cause hypocalcaemia due to a reduced vitamin D3 level, the PTH level would be expected to increase in compensation.  This would be known as secondary hyperparathyroidism due to hyperplasia of the parathyroid glands, in response to low serum calcium levels. By contrast this patient demonstrates low PTH levels. Their renal function is also normal, ruling out a diagnosis of CKD.
10007839
e
Chronic kidney disease resulting in the deficiency of active vitamin D3 production
QuestionChoice
No, this is not the single best answer. This is possible in type 1 polyglandular syndrome, however given the patient's history of a previous partial thyroidectomy, iatrogenic to the parathyroid glands is far more likely.
10007836
b
Hypoparathyroidism secondary to autoimmune damage to the parathyroid glands resulting in atrophic changes
QuestionChoice
No, this is not the correct answer. The patient has a serum PTH level below the normal range.
10007838
d
Primary hyperparathyroidism secondary to an adenoma of one or more of the parathyroid glands
QuestionChoice
No, this is not the single best answer. This is a possible underlying explanation but not the most likely diagnosis considering the patient's history of a previous partial thyroidectomy.
10007837
c
Familial associated hypoparathyroidism
Concept
Chapter
2693
4625
Hypoparathyroidism
Topic
167
Endocrine physiology
14114
A 23-year-old man presents to the GP with recent paraesthesia bilaterally on his upper and lower limbs. He has also been experiencing involuntary contraction of his muscles. He has recently undergone a partial thyroidectomy, but has no other past medical or surgical history.


Neurological examination is otherwise entirely normal.


The GP requests some investigations shown below:


||||
|---------------------------|:-------:|------------------------------|
|Calcium|0.9 mmol/L|2.2 - 2.6|
|Alkaline Phosphatase (ALP)|64 IU/L|25 - 115|
|Parathyroid Hormone|0.3 pmol/L|1.6 - 8.5|

His full blood count and renal function are normal.


Which of the following is the most likely underlying diagnosis?
a