A 48-year-old woman underwent a thyroidectomy with central neck dissection due to papillary thyroid carcinoma. On day 2 postoperatively, she developed irritability, dysphagia, difficulty breathing, and spasms in different muscle groups in her upper and lower extremities. The vital signs include blood pressure 102/65 mm Hg, heart rate 93/min, respiratory rate 17/min, and temperature 36.1℃ (97.0℉). Physical examination shows several petechiae on her forearms, muscle twitching in her upper and lower extremities, expiratory wheezes on lung auscultation, decreased S1 and S2 and the presence of an S3 on cardiac auscultation, and positive Trousseau and Chvostek signs. Laboratory studies show: Ca2+ 4.4 mg/dL Mg2+ 1.7 mEq/L Na+ 140 mEq/L K+ 4.3 mEq/L Cl- 107 mEq/L HCO3- 25 mEq/L Administration of which of the following agents could prevent the patient’s condition?
AAnticonvulsants prior to and for 1 week after the operation
BVitamin D and ionic calcium prior to and 2 weeks after the operation
CPotassium supplementation prior to and 2 weeks after the operation
DCalcium gluconate intraoperatively
EMagnesium sulfate intraoperatively
A 38-year-old woman undergoes hemithyroidectomy for treatment of localized, well-differentiated papillary thyroid carcinoma. The lesion is removed with clear margins. However, during the surgery, a structure lying directly adjacent to the superior thyroid artery at the upper pole of the thyroid lobe is damaged. This patient is most likely to experience which of the following symptoms?
AShortness of breath
BWeakness of shoulder shrug
CVoice pitch limitation
DDifficulty swallowing
EIneffective cough
A 50-year-old woman comes to the physician because of palpitations and irritability. Over the past 4 months, she has had several episodes of heart racing and skipping beats that lasted between 30 seconds and several hours. She has also been arguing with her husband more, often about the temperature being too warm. The patient has also lost 8.8-kg (19.4-lb) over the past 4 months, despite being less strict with her diet. She has mild asthma treated with inhaled bronchodilators. Her pulse is 102/min and blood pressure is 148/98 mm Hg. On physical examination, the skin is warm and moist. A mass is palpated in the anterior neck area. On laboratory studies, thyroid stimulating hormone is undetectable and there are antibodies against the thyrotropin-receptor. Thyroid scintigraphy shows diffusely increased iodine uptake. Two weeks later, a single oral dose of radioactive iodine is administered. This patient will most likely require which of the following in the long-term?
APropranolol therapy
BNear-total thyroidectomy
CL-thyroxine therapy
DMethimazole therapy
EEstrogen replacement therapy
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