How is hypocalcemia as a complication of thyroidectomy?

Incidence (increased risk in reop, transient 1.6-83%, permenant 0-14%) Presentation (acral numbness and parasthesia, perioral parasthesia, general muscle cramps, carpopedal spasm, seizures, cardiac arrhythmias, chvostic sign) Potential factors (hemodilution [2ary stress w/elevation of Ca], calcitonin release, hungry bone syndrome [hyperthyroidism, osteodystrophy], autoimmune fibrosis [PTH vascularization affected] hypoparathyroidism [2art to trauma, devascularization, inadvertent excision of 1 more more PTH gland [we preserve them by identifying them and ligating blood supply to distal vessels) Independent risk factors for hypocalcemia: bilateral thyroidectomy, elevated fT4 level, parathyroid autotransplant