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A 55 year old man presents with a 3 month history of increased no muscle cramps on the lower back, legs, feet and hands. more recently he has noticed some tingling and burning in the fingers and around the mouth. Four months ago he had a thyroidectomy for a larger multinodular goiter. He takes thyroxine and thiazide diuretic for mild hypertension He has  a sedentary job works long hours and spends little time in any in outdoor.

a) What would be your differential diagnosis

b) How would you examined this patient.

c) What laboratory tests would you order.

d) What is the diagnosis.

e) Explain the management of this patient.

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