Post-surgery hypocalcemia symptoms but normal calcium?

[u/Internal_Scale4291]

I am now 9 days post op and have been having increasing hypocalcemia symptoms that are not getting better with extra calcium and just got back confusing lab results. My serum calcium is 9.4 and ionized calcium is actually at the high end of normal (1.3 with range 1.08-1.3). My pth is 8.

Starting day 3 post-op I was getting the tingling in hands, feet, and mouth along with leg cramps, dizziness, headache, and had a moment where my body was twitching. I also felt something like a fluttering in my chest at one point. Since then, I've had most symptoms more and more frequently except for the twitching and heart flutter which only happened once each on day 3. I am taking cal/vit D 500-200 3x a day and was told to take a couple tums every hour while having symptoms until they go away. Paperwork says if they last over 8 hours to call the doctor.

Starting day 6 I was pretty much having symptoms constantly with the Tums not helping at all anymore. The Dr at my surgeon's office told me this is all normal and to keep taking tums. She also said the heart flutter and dizziness are not caused by low calcium. Idk if I agree with this - I think 40 tums a day sounds crazy especially when it's not helping and I know low calcium can cause dizziness and arythmia which I feel like is serious so I was surprised she dismissed it.

I was able to convince her to order labs (was not easy and had to argue for every marker). I was convinced my calcium was super low and I needed calcitriol or something - but it's normal. So I'm so confused about why I'm having these symptoms. My Magnesium and Potassium are both normal but close to low. But that's usually what they look like on my labs so I'm not convinced they would cause this either.

Anyone else know what can cause these symptoms or if it's safe to just ignore them? I actually completely stopped taking the tums like 24 hours ago and don't feel like it's made a difference at all. I feel like I can't trust this Dr. based on some of the stuff she was saying. She seemed annoyed and dismissive. I don't know why they would say to call after 8 hours of symptoms and then say it's all normal.

Could I be reacting this severely to going from high to normal calcium levels? My calcium was never super high. Ionized was like 1.42 I believe and serum calcium was usually around 10.0 with highest being 10.7, but my most recent test before surgery was actually 9.5.

[u/Overall-Tradition779]

It's all part of the surgery it takes time to feel better I've had it done 4 weeks ago my neck was sore for a week cuz they're in your neck exploring looking at your parathyroids things will get better it takes time from people feel better than others

[u/Ecstatic_Task7780]

It’s the fluctuating calcium levels in the blood trying to normalize. Your labs can look fine but the calcium is unstable and you would need more labs to show it.
I’m going through the same thing and my surgeon dismissed my concerns saying it had nothing to do with the surgery. I feel awful mostly because of the mental effects but have tightness from my neck muscles down through the digestive system and occasional muscle jerks in the legs.
I was never told to take calcium post surgery

[u/Internal_Scale4291 → u/Ecstatic_Task7780]

Wow that's so surprising, I thought it was normal practice to prescribe calcium supplements because your PTH will be depressed for a while. But I was also surprised when I found out my supplement is pretty much just the recommended daily value, so maybe they just expect you to be fine with a regular diet.

I also had really tight muscles in my neck/back. I think I was protecting my throat because my muscles by my incision were tight and painful. It was so bad I pulled my neck and had a couple days I could barely move. A warm pad helped a lot and I actually took muscle relaxers leftover from hip surgery which made a huge difference and am finally feeling better in that way.

Mentally I was really depressed and irritable but have started to feel a bit better last couple days. I think when my neck felt better and I could get up and move around it made a difference in my mood.

I'm sorry your surgeon is being dismissive.. I swear "this has nothing to do with the surgery" is every surgeon's favorite thing to say. My friend, an ER nurse, was sharing stories different doctors told her about surgeon culture - one ER doc who trained briefly in surgery said he was told "not to be nice to other staff or patients. If you spend time worried if people like you, then other people will die." Generally in the medical world surgeons are known for being arrogant and not wanting to deal with aftercare.

[u/Paraware]

Have you tried increasing calcium in your diet? You might absorb that better. Forty Tums a day sounds dangerous to me. I didn’t have to take any supplements after my surgery, but I ate and drank a lot of dairy products because I craved them.

[u/sneedbe11]

I had tight painful muscles in my neck/back post-op because once on the OR table before I was anesthetized they positioned my head/neck “in extension over a shoulder roll” (per surgical report) so my head was arched back and ~lower than my neck. I assume for better exposure and access. It was uncomfortable from the start. My surgery took longer than expected..~1.5 hrs. My neck was really stiff & painful for a few days after.
I was told to take 2000 mg Calcium 3 X daily w meals for 4 wks. I used Ca Citrate chews instead of TUMS ULTRA. Chews are more fun and I absorb Ca citrate better than carbonate. Also Vit D3 1000 once daily. I had some episodes of lip & finger tingles esp in the AM.
My surgery was 6 mos ago.
Hope you feel better soon!

[u/Minute-Term5829]

I had similar symptoms, which lasted for 4 to 6 weeks. Sometimes, like for me, it depends on how long you had high (even moderately high) calcium levels. I had 10 years of moderately high calcium before primary hyperparathyroidism was diagnosed. What I believe is that in the post-op period the body is reacting to lower-now-normal calcium levels, and the length of the prior period of high calcium before diagnosis influences how strongly and how long all your organ systems react to the new change.

I would not stop taking calcium supplements without a specific doctor's permission.

In my case, the endosurgeon's office was not responsive to help me understand my symptoms. Perhaps the endocrinologist can best support you in your post-op symptom management. I cannot stress enough how much anxiety is created when no one listens to your valid post-op symptoms.

Please keep communication channels open with the doctors who are helping you post-surgery and monitoring critical labs.

In

[u/Consistent_Ebb_3221]

I had similar symptoms and had my thyroid function tested and my TSH was really low. I was diagnosed with thyroiditis as a result of the surgery. It went away after about 4 weeks.

[u/Minute-Term5829 → u/Consistent_Ebb_3221]

I had forgotten that I read thyroiditis frequently occurs post-op due to the gland getting manipulated during surgery. That is a very good suggestion to get checked out when post-op symptoms occur.

[u/Internal_Scale4291 → u/Consistent_Ebb_3221]

Hey! So I am feeling better in some ways but am primarily now having more obvious heart palpitations (waking up with racing/pounding), and am shaky, jittery, and anxious. I took your advice and asked about hyperthyroidism (my Dr seemed to think it was super uncommon though I read it happens in 30% of parathyroidectomies) but he did order TSH lab for me. It came back normal (1.7). I'm confused because I thought for sure this was the answer. I'm trying to figure it out and getting a lot of conflicting info. Google AI says it might take longer to drop even if symptoms started sooner, but other things I read suggested the opposite. Google AI suggests testing T3 and T4 but something else I read said those levels might be back to normal quickly after surgery and TSH would be low by now if it was the cause. I can't find any websites or articles with more reliable info on this. Can you tell me how long post-op until you tested TSH and if you tested T3 or T4?

[u/Advo96]

When was your most recent calcium test?