Carpopedal spasm (post-thyroidectomy hypoparathyroidism)

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Last modified 02/04/2015

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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.

Fig. 141.1 Trousseau’s sign.

(With permission from Burnside, McGlynn 1987.)

Diagnosis

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