 Welcome back to our question of the week Let's move right into the question today, we're going to hide our answer choices until we read the full question and to do some sort of an answer and As always we're going to begin with the last sentence or the question of the vignette before we read the rest Which of the following is a potential complication of this treatment? This tells me that all I'm looking for is what the treatment is and the rest I probably don't have to pay much attention to Let's go ahead and read the question a 30 year old patient comes the physician due to a bump in her neck Physical examination reveals a solitary thyroid nodule laboratory studies show an increased serum calcitonin level and a pentagastrin induced rise in the secretion of calcitonin a Biopsy confirms the presence of a carcinoma the patient is scheduled for a total thyroid ectomy Which are the following is a potential complication of this treatment? So we're telling being told that the patient will be having a total thyroid ectomy. Sometimes these questions may not give you the Choice that they're having a total thyroid ectomy They may have you deduced that the total thyroid ectomy is occurring and then you have to find out what the Complications of the treatment is so you can't just ignore everything But in this case we're told there's a total thyroid ectomy. What are some potential complications with the total thyroid ectomy? Well, we know there are nerves that run alongside and close to the thyroid So if we do a thyroid ectomy, we can lacerate some of those nerves I know the pair of thyroid sit around the nerve of around the thyroid as well And some other structures in that area muscles and whatnot So let's remember those things and we'll take that into consideration as we check our answer choices All right. A is acromegaly B is cretinism or cretinism C is hypertension D hypo parathyroidism or E renal osteodystrophy Take a minute come up with your answer and write your answer in the comments below Well, right from the start. I'm seeing D as a potential answer here because we mentioned parathyroid as we were Working through this question, but let's go through and try and eliminate some of these options So let's start at the top a acromegaly Acromegaly, this is an excess of growth hormone mostly going to be in in adults their growth plates have already fused there's no association with a thyroid or a Thyroid ectomy in this situation. So acromegaly. I know is not going to be my correct answer So we'll mark that off the list Cretanism cretinism is it is a hypothyroidism, but it's a hypothyroidism of a fetus Okay, this is going to be due to problems with the Thyroid functioning and the thyroid Developing it's not going to be something a 30 year old patient will find Due to a cancer. So cretinism to me is not going to be a good option here as well See hypertension while we know hypertension can be caused by a lot of things Taking a thyroid out is not going to be a cause of of hypertension. So that's a bad answer Let's skip over D for just a minute and go to E renal osteodystrophy. So renal osteodystrophy Comes along with patients that have renal failure. We can see a lot of the signs that are associated with something that could have been caused by Removing the thyroid But I don't really think we're going to have a lot of issues with This being caused by removing the thyroid So in turn my answer is going to be D hypoparathyroidism and that is our correct answer D So what we're seeing here is the Parathyroids sit on top of the thyroid. So if we're removing the thyroid gland you have to be very very careful To not remove the parathyroids and oftentimes it's still pretty almost impossible to do that so we do have a potential to have a Secondary hypoparathyroidism due to that total thyroid ectomy What will be some signs and symptoms that will see the patient having when they have that total thyroid ectomy that? Affects the parathyroids well hypoparathyroid can lead us to hypocalcemia and then on top of that We can have hyperphosphatemia So what is a hypocalcemia symptoms tingling on the lips tingling in the fingers muscle spasms? They can have a positive Chavstex sign So if we tap on the facial nerve in the cheek that will cause a contraction of the facial muscles And they can also have a positive trousseau sign Which is when you occlude the brachial artery in the upper part of the arm It's going to cause a carpal spasm down in the distal portion of the arm Now as we mentioned renal osteodistrophy that Can give us some signs and symptoms that would be similar to hypoparathyroidism However, this is a completely different mechanism that's causing this hypoparathyroid signs and symptoms It's not due to the actual removal of the thyroid. Okay