**Question:** Complications of total thyroidectomy include all except:

A. Hypocalcemia
B. Hypoparathyroidism
C. Hypothyroidism
D. Hyperthyroidism

**Correct Answer:** D. Hyperthyroidism

**Core Concept:** Total thyroidectomy is a surgical procedure to remove the entire thyroid gland, which is used to treat various thyroid disorders such as thyroid cancer, hyperthyroidism, and thyroid nodules. Thyroid hormones are crucial for regulating the body's energy homeostasis, growth, and development.

**Why the Correct Answer is Right:** Hyperthyroidism is a condition where the thyroid gland produces excessive amounts of thyroid hormones (T3 and T4). After a total thyroidectomy, there is a temporary or permanent loss of thyroid hormone production, leading to hypothyroidism. In some cases, the remaining parathyroid glands might compensate for the loss of thyroid function, preventing the development of hyperthyroidism.

**Why Each Wrong Option is Incorrect:**

A. Hypocalcemia: This refers to low blood calcium levels. Total thyroidectomy can cause hypocalcemia due to destruction of parathyroid glands, which are responsible for calcium regulation.

B. Hypoparathyroidism: Similar to hypocalcemia, hypoparathyroidism is low parathyroid hormone (PTH) levels. After total thyroidectomy, there is a loss of PTH production, leading to hypocalcemia.

C. Hypothyroidism: As mentioned earlier, after total thyroidectomy, there is a temporary or permanent loss of thyroid hormone production, which leads to hypothyroidism. This option is incorrect because the correct answer (hyperthyroidism) is also a complication of total thyroidectomy.

**Clinical Pearl:** Understanding the relationship between thyroid function, parathyroid function, and the complications of thyroidectomy is crucial for medical students and practicing physicians. In clinical practice, patients may present with symptoms related to hypocalcemia, hypoparathyroidism, or hypothyroidism post-thyroidectomy. Correct diagnosis and management of these complications are essential to ensure optimal patient care and outcomes.