Question

What is NOT likely to be the cause of stridor occurring 2 hours after a thyroidectomy?

• A. Hypocalcemia
• B. Wound hematoma
• C. Tracheomalacia
• D. RLN injury bilaterally

Hint:

Hypocalcemia after thyroidectomy takes a day or more to cause symptoms, not 2 hours.

Answer 1

The Correct Option is A

The question is about timing: which cause of post thyroidectomy stridor does not fit a 2 hour window after surgery. Match each option to how soon it typically appears.

1. Hypocalcemia: Calcium falls gradually as parathyroid hormone drops after the glands are disturbed during surgery. Symptoms like laryngospasm usually take about 1 to 3 days to appear, so this does not fit a 2 hour timeline.
2. Wound hematoma: Bleeding under a closed neck wound can collect within hours and press on the airway, so this can easily cause stridor at 2 hours.
3. Tracheomalacia: A trachea weakened by a long standing large goiter can cave in as soon as the supporting mass is removed, so this can also show up right after surgery.
4. RLN injury bilaterally: If both nerves are damaged, both cords sit close together right from extubation, so stridor can appear immediately in the recovery room.

Three of the four causes act fast enough to explain stridor at 2 hours. Only hypocalcemia needs more time to develop, so it is the one that does not fit.

Let's summarize:

• Hematoma, tracheomalacia, and bilateral RLN injury can all cause stridor within hours of surgery.
• Hypocalcemia related stridor usually takes 1 to 3 days to show up.

So hypocalcemia is not a likely cause this early.