A 45-Year-Old Man Is Evaluated for a Progressively Enlarging Neck

A 45-year-old man is evaluated for a progressively enlarging neck mass and hoarseness.  Physical examination shows an enlarged and nontender left thyroid lobe.  Fine-needle aspiration biopsy is positive for papillary thyroid cancer, and a thyroidectomy is subsequently performed.  On the second postoperative day, the patient develops tingling around the mouth and muscle cramps in his lower extremities.  Blood pressure is 120/80 mm Hg, pulse is 82/min, and respirations are 14/min.  Physical examination shows normal muscle strength and deep tendon reflexes.  Light tapping anterior to the ear elicits twitching of the lower facial muscles.  An increase in which of the following best explains this patient's current symptoms?

A) Calcium binding by albumin
B) Calcium release from bones
C) Hydroxylation of vitamin D
D) Intestinal phosphate absorption
E) Urinary calcium excretion

Correct Answer:

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