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Chvostekrsquos sign a video demonstration
Sadishkumar Kamalanathan1 Karthik Balachandran1 Girish Parthan1 Abdoul Hamide2
1Department of Endocrinology Jawaharlal Institute of Post Graduate Medical Education and Research Puducherry India2Department of Medicine Jawaharlal Institute of Post Graduate Medical Education and Research ( JIPMER) Pondicherry India
Correspondence to Dr Sadishkumar Kamalanathan sadishkkgmailcom
DESCRIPTIONA 53-year-old lady was referred to the Endocrinologydepartment of our institute for management of postsur-gical metabolic complaints following near total thyroi-dectomy done elsewhere for obstructive nodular goitre2 weeks back She was started on thyroxine of 150 mcgand calcium of 3 g in divided doses postoperatively Herclinical evaluation showed her to have positiveChvostekrsquos (video 1) and delayed Trousseaursquos sign Hercalcium was documented to be 14 mmoll (normalrange (NR) 2ndash25) phosphate 24 mmoll (NR 08ndash15)and iPTH 05 pmoll (NR 12ndash58) Her fT4 was 122pmoll (NR 103ndash232) and thyroid stimulatinghormone was 38 mIUl (NR 05ndash45) Her biopsy wasconfirmed to be nodular goitre Postsurgical hypothy-roidism with hypoparathyroidism was diagnosed Shewas additionally started on calcitriol (025 mcg twicedaily) and calcium dose modified (2 g in divided doses)and soon her Chvostekrsquos sign resolved High dosesof calcium may not be sufficient in the management ofhypoparathyroidism and often requires addition ofactive vitamin D
Chvostekrsquos sign was attributed initially to increasedsensitivity of the facial nerve to mechanical stimuli inidiopathic epidemic tetany1 2 Traditionally it is elicitedby tapping on the face at a point just anterior to the earand just below the zygomatic bone3 A positive responseis represented by twitching of the ipsilateral facialmuscles suggesting neuromuscular excitability caused byhypocalcaemia Although classically described with hypo-calcaemia due to hypoparathyroidism it is also elicited insome young healthy children and alkalotic states asduring vomiting and hyperventilation It is very easy totest in clinical practice compared with Trousseaursquos signand hence its clinical significance
Learning points
A positive Chvostekrsquos sign represents increasedneuromuscular excitability caused by hypocalcaemia
It can be even elicited in some young healthy childrenand alkalotic states following vomiting andhyperventilation
Resolution of Chvostekrsquos sign occurs with effectivetreatment of hypoparathyroidism with calcium andactive vitamin D
Competing interests None
Patient consent Obtained
REFERENCES1 Krogh L Wynne JM Cywes S The value of Chvostekrsquos sign in tetany
S Afr Med J 196842846ndash72 Kugelberg E The mechanism of chvostekrsquos sign AMA Arch Neurol
Psychiatry 195165511ndash173 Hoffman E The Chvostek sign a clinical study Am J Surg 19589633ndash7
Video 1 Video clip demonstrating Chvostekrsquos sign inpost-thyroidectomy patient
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Please cite this article as follows (you will need to access the article online to obtain the date of publication)
Kamalanathan S Balachandran K Parthan G Hamide A Chvostekrsquos sign a video demonstration BMJ Case Reports 2012101136bcr-2012-007098Published XXX
Become a Fellow of BMJ Case Reports today and you can Submit as many cases as you like Enjoy fast sympathetic peer review and rapid publication of accepted articles Access all the published articles Re-use any of the published material for personal use and teaching without further permission
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2 of 2 BMJ Case Reports 2012 doi101136bcr-2012-007098
on 16 April 2020 by guest P
rotected by copyrighthttpcasereportsbm
jcom
BM
J Case R
eports first published as 101136bcr-2012-007098 on 8 October 2012 D
ownloaded from
This pdf has been created automatically from the final edited text and images
Copyright 2012 BMJ Publishing Group All rights reserved For permission to reuse any of this content visithttpgroupbmjcomgrouprights-licensingpermissionsBMJ Case Report Fellows may re-use this article for personal use and teaching without any further permission
Please cite this article as follows (you will need to access the article online to obtain the date of publication)
Kamalanathan S Balachandran K Parthan G Hamide A Chvostekrsquos sign a video demonstration BMJ Case Reports 2012101136bcr-2012-007098Published XXX
Become a Fellow of BMJ Case Reports today and you can Submit as many cases as you like Enjoy fast sympathetic peer review and rapid publication of accepted articles Access all the published articles Re-use any of the published material for personal use and teaching without further permission
For information on Institutional Fellowships contact consortiasalesbmjgroupcom
Visit casereportsbmjcom for more articles like this and to become a Fellow
2 of 2 BMJ Case Reports 2012 doi101136bcr-2012-007098
on 16 April 2020 by guest P
rotected by copyrighthttpcasereportsbm
jcom
BM
J Case R
eports first published as 101136bcr-2012-007098 on 8 October 2012 D
ownloaded from
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