A 69-Year-Old Woman Underwent Thyroidectomy Due to Thyroid Cancer

A 69-year-old woman underwent thyroidectomy due to thyroid cancer.  The surgery was uncomplicated.  Three hours afterward, the patient developed slurred speech and right-sided weakness.  Temperature is 36.3 C (97.3 F) , blood pressure is 140/86 mm Hg, pulse is 90/min, and respirations are 18/min.  On examination, the patient is alert and awake, but her speech is incomprehensible.  Strength is 2/5 in both right upper and lower extremities.  Sensations are decreased on the right side of the body.  The dressing covering the operative site on the neck is dry. There is no stridor.  The extremities are warm with normal capillary refill time.  Neurologic examination prior to the surgery showed no abnormalities.  Serum glucose and calcium concentration are normal.  Which of the following is the most appropriate next step in management of this patient?

A) Arterial blood gas analysis
B) CT scan of the head without contrast
C) CT scan of the soft tissue of the neck
D) Serum free T4 level
E) Serum phosphorus level

Correct Answer:

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