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Paper text:
the most common causes of stridor in adults are abscesses or swelling of the upper airway , tumors and paralysis or malfunction of the vocal cords .
we report an elderly patient who presented with dyspnea and laryngeal stridor attack because of hypocalcemia .
the patient had been suffering from stridor and dyspnea episodes for 2 years , and the etiology had not been found until her evaluation at our department .
a 54-year - old woman complaining of dyspnea and stridor was admitted to our hospital . she had a history of intermittent stridor and dyspnea for 2 years . in her medical history
, it was learned that she had undergone a thyroidectomy operation 2 years ago . after that operation , she had not gone to the control examinations , and she had not used any medical treatment .
but she had visited the pulmonologist because of stridor and dyspnea several times . in her previous examinations , fiberoptic bronchoscopy , thorax computed tomography and respiratory function tests were applied , and these tests were evaluated as normal by the pulmonologist , but her pth level , thyroid function tests and calcium level had not been checked yet . on examination in our emergency department , she was tachypneic , and her accessory muscles were joining in respiration .
on auscultation of her chest , normal vesicular breath sounds were heard ; there was no wheezing or rhonchus .
arterial blood gases demonstrated respiratory alkalosis ( ph : 7.46 , pco2 : 33.2 , po2 : 120.9 , hco3 : 23.7 , so2 : 98.7 , ica : 0.272 
the blood calcium level was 3.3  mg / dl ; other blood tests including thyroid function tests were normal : parathormone ( pth ) : 2.56  pg / ml ( 1565  pg / ml ) , 25-oh vitamin d3 : 9.91  ng / ml ( 11.142.9  ng / ml ) . a 20-ml calcium gluconate 10% solution ( 180  mg elemental calcium )
was given to the patient in 4 h. after this replacement therapy , the severity of her stridor decreased .
the calcium level at that moment was 4.9  mg / dl , ica : 0.879 
an additional 40  ml of calcium gluconate was given for 16 h. her calcium level returned to baseline ( 7.6  mg / dl ) after 20 h of calcium replacement therapy , and complete resolution of the stridor was achieved .
pulmonary auscultation was normal , and the patient was discharged from the emergency department for further evaluation at the endocrinology outpatient department .
the patient was evaluated after 2 months , and during this period there were no stridor attacks .
the main postoperative complications of thyroidectomy include injury to the parathyroid glands and to the laryngeal nerves .
transient hypocalcemia is commonly seen after thyroid surgery , as biochemical disorders are described in more than 83% of the cases .
hypocalcemia leads to increased neuromuscular irritability and may present with circumoral numbness , paresthesias of the hands and feet , and muscular cramps , or when severe , with laryngospasm , focal or generalized tonic muscle cramps , or seizures .
myocardial dysfunction and prolongation of the qt interval may also occur . in the literature ,
post - thyroidectomy hypoparathyroidism has been reported with a varying incidence , ranging from less than 1% to as high as 15% .
the extension of the thyroid resection procedure is a risk factor for the onset of clinical and laboratory hypoparathyroidism , while age above 50  years is a risk factor for clinical hypoparathyroidism .
patients must be carefully observed in the postoperative period and have their laboratory workup done , especially those categorized as high risk patients . in the reported case we explained that the patient had not gone to her control examinations , and her parathyroid hormone level had never been evaluated .
severe hypocalcemia and hypomagnesemia resulting from malabsorbtion syndrome secondary to celiac disease in an elderly woman leading to laryngospasm has been reported .
hypomagnesemia also results in increased neuromuscular irritability and perioperative laryngospasm from hypomagnesemia , and secondary hypocalcemia in a diabetic patient has also been reported . in conclusion
, it is suggested that in case of recurrent laryngospasm , electrolyte measurements of magnesium and calcium might be helpful in the diagnosis and treatment of the patients .
hypocalcemia with stridor is a well - known condition in the pediatric age group but has rarely been reported in the elderly . 
 we report an elderly patient who presented with dyspnea and laryngeal stridor attack caused by hypocalcemia . 
 the patient had been suffering from stridor and dyspnea episodes for 2 years , and the etiology had not been determined until the evaluation in our department . 
 the cause of stridor was hypocalcemia secondary to thyroidectomy . 
 complete resolution of stridor was achieved by calcium replacement therapy .