A nurse is assisting with the care for a client following a thyroidectomy. Which of the following findings should alert the nurse to the possibility of parathyroid gland injury?

The parathyroid glands, which regulate calcium homeostasis, are embedded in or near the thyroid gland and can be inadvertently removed or devascularized during thyroidectomy. Injury to the parathyroid glands leads to hypoparathyroidism, causing a drop in parathyroid hormone (PTH), which results in hypocalcemia. Hypocalcemia manifests with neuromuscular excitability, and muscle twitching — along with tetany, Chvostek's sign, Trousseau's sign, and paresthesias — is a classic early indicator of this complication. The nurse must monitor for these signs closely in the immediate postoperative period. Anorexia is not a specific sign of hypoparathyroidism and is a nonspecific finding common after any surgery. Hoarseness is also a postoperative concern after thyroidectomy, but it indicates damage to the recurrent laryngeal nerve rather than the parathyroid glands. Blurred vision is not associated with parathyroid injury or hypocalcemia in the typical clinical presentation and does not alert the nurse specifically to parathyroid damage. Recognizing muscle twitching as the hallmark sign of hypocalcemia from parathyroid injury allows for prompt notification of the provider and timely calcium replacement therapy.