My friend is a 66 y/o female.She experiences repeated attacks of muscle cramps and intentional tremor over her extremities. Numbness is also present. Several months ago, she received total thyroidectomy for papillary thyroid cancer and has taken thyroid hormone supplement ever since. Now nerve conduction velocity (NCV) investigation shows generalized nerve conduction delays over the extremities.
Lab test: normal liver function, BUN/Creatinine 18/1.1 mg/dl, albumin 3.9 g/dl, Na 143 mEq/L, K 4.2 mEq/L, total calcium 6.8 mg/dl, phosphate 4.5mg/dl.
1. What signs will be found on physical examination?
2. What the definitive diagnostic test will be performed to confirm the diagnosis?
3. What is the most straightforward and specific treatment? If it is not available, what will be the second best?