Carpopedal spasm (post-thyroidectomy hypoparathyroidism)

141 Carpopedal spasm (post-thyroidectomy hypoparathyroidism)



Instruction


Look at this patient’s hands.



Salient features



History




• History of thyroid surgery


• Paraesthesias of fingers, toes and circumoral region


• Muscle cramping, carpopedal spasm, laryngeal stridor, convulsions.



Examination




• Spasm of the hands: fingers are extended, except at the metacarpophalangeal joints, and the thumb is strongly adducted.


Proceed as follows:



• Look at the feet for spasm


• Investigate as follows:


• Tap over the facial nerve (in front of the tragus of the ear): there is contraction of the lips and facial muscles (Chvostek’s sign or Chvostek–Weiss sign)

• Inflate the BP cuff to just above the systolic pressure for 3 min; this will cause the hand to go into spasm: Trousseau’s sign (Fig. 141.1)

• Look into the mouth for candidiasis (may be seen in primary hypoparathyroidism) and defective teeth

• Finger nails may be thin and brittle

• Check for thyroidectomy scar

• Look for cataracts.

• Tell the examiner that you would like to perform the following tests:


• Do a skull radiograph (looking for basal ganglia calcification)

• Check serum total and ionized calcium, albumin, phosphorus, magnesium and parathromone (PTH)

• ECG for prolonged QT intervals and T wave abnormalities

• Slit-lamp examination for early posterior lenticular cataract formation.

image

Fig. 141.1 Trousseau’s sign.


(With permission from Burnside, McGlynn 1987.)



Diagnosis


This patient has carpopedal spasm (lesion) caused by hypoparathyroidism as a complication of thyroidectomy (aetiology).

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Carpopedal spasm (post-thyroidectomy hypoparathyroidism)

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