Figure 1. Metacarpophalangeal joint flexion, extension of the distal interphalangeal and proximal interphalangeal joints and finger adduction (Trousseau’s sign) during blood pressure measurement.
A 22 year old woman was admitted for numbness and tingling of her hands, feet and face 72 hours after total thyroidectomy for a nonfunctional goiter. Initial ionized calcium was 3.2 mg/dL and magnesium 1.2 mg/dL. The patient received 1 ampule of calcium gluconate (90 mg calcium) and 2 mg MgSO4 intravenously. The next day a rapid response was called. The patient was lethargic, and said she felt very ill, although she could not be more specific. Her ionized calcium was 4.3 mg/dL. She demonstrated Trousseau's sign when her blood pressure was measured with an arm cuff (Figure 1). She also had a positive Chvostek's sign. She did not have stridor or papilledema. She received another ampule of calcium gluconate and 2 mg MgSO4 intravenously and was transferred to the ICU, where she had a 60 sec duration generalized seizure. A calcium gluconate infusion was started, that delivered 990 mg calcium as calcium gluconate over 20 hours. Oral calcium and vitamin D supplements were started. PTH levels confirmed hypoparathyroidism, likely secondary to a surgical mishap at the time of thyroidectomy.
Emad Wissa MD and Robert A. Raschke MD
Banner Good Samaritan Regional Medical Center
Phoenix, AZ
Reference as: Wissa E, Raschke RA. Medical image of the week: Trousseau's sign. Southwest J Pulm Crit Care. 2013;6(3):128. PDF