Hypocalcemia Quiz: Ace Your Exams

A 46-year-old female with a history of depression, anxiety, and hyperthyroidism presents to the emergency department with muscle spasms. She states, “I have had trouble sleeping for the past two weeks because my legs keep twitching.” She has also had worsening thoughts of self-harm and has rarely left her house. The patient recently underwent a thyroidectomy and is taking escitalopram for management of the depression. During the interview, she begins seizing. Temperature is 37.0°C (98.6°F), pulse is 82/min, respirations are 8/min, and blood pressure is 120/74 mmHg. On physical exam, the patient is noted to have a well-healing surgical scar over the midline of the neck. She has contractions of the upper and lower extremities bilaterally. Contraction of the ipsilateral facial muscles are elicited when the muscles just anterior to the ear are tapped. Which of the following best describes the etiology of this patient's presentation?