A client is scheduled for a thyroidectomy. What post-operative complication requires most urgent assessment in the first 24-48 hours?

POST-THYROIDECTOMY COMPLICATIONS require vigilant monitoring in the immediate post-operative period.

Two priority concerns: (1) HYPOCALCEMIA / HYPOPARATHYROIDISM: The parathyroid glands (4 tiny glands on the posterior thyroid) are at risk of damage or inadvertent removal during thyroidectomy; if parathyroid function is lost, calcium regulation is disrupted; hypocalcemia develops within 24-72 hours; signs and symptoms: tingling/numbness around mouth and in extremities; POSITIVE TROUSSEAU'S SIGN (carpal spasm when BP cuff inflated above systolic for 3 minutes); POSITIVE CHVOSTEK'S SIGN (facial twitching when tapping facial nerve); muscle cramps; tetany; SEIZURES in severe hypocalcemia.

Treatment: IV calcium gluconate; oral calcium and vitamin D supplements long-term; (2) HEMORRHAGE AND AIRWAY COMPROMISE: The thyroid is highly vascular; bleeding into the surgical site can cause rapid hematoma expansion in the confined neck space; the hematoma can compress the trachea causing airway obstruction — this is a SURGICAL EMERGENCY; signs: rapidly expanding neck swelling; stridor; dyspnea; tracheal deviation.

Treatment: Emergency wound opening at the bedside if acute obstruction (emergency supplies kept at bedside); surgical return to OR.

Other complications: Laryngeal nerve damage causing hoarseness (recurrent laryngeal nerve injury — assessed by voice quality); thyroid storm if inadequately prepared pre-operatively.