title: Hypocalcemia complicating near-total thyroidectomy in patients with coexisting lipid malabsorption due to biliopancreatic diversion.
abstract: BACKGROUND
  Patients who have undergone biliopancreatic diversion (BPD) show a high incidence of mild hypocalcemia, which may become symptomatic and life-treating after an extensive thyroid operation.
  
  
  METHODS
  4 cases are reported of women who had undergone BPD, who subsequently underwent near-total thyroidectomy for extensive multinodular goiter.
  
  
  RESULTS
  The first patient developed severe symptomatic hypocalcemia with malnutrition in the long-term, that required elongation of the common limb of the BPD. The second and third patients developed severe symptomatic hypocalcemia immediately after the thyroidectomy. In the fourth patient, preventive and continuing intravenous administration of calcium gluconate was started in the early hours after the thyroidectomy and allowed a safe and fast discharge home.
  
  
  CONCLUSIONS
  In patients who are candidates for both thyroid and bariatric surgery, surgeons should carefully evaluate the opportunity to perform the thyroidectomy first. BPD patients who later undergo thyroidectomy should be perioperatively routinely treated with intravenous calcium and, whenever appropriate, intravenous vitamin D, to allow a safe and rapid discharge.
authors.affiliation: Department of Internal Medicine, CNR Centro di Fisiopatologia dello Shock, Catholic University, School of Medicine, Rome, Italy. melania.manco@rm.unicatt.it
authors.forename: Melania
authors.initials: M
authors.lastname: Manco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nanni
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tondolo
authors.forename: Amerigo
authors.initials: A
authors.lastname: Iaconelli
authors.forename: Aldo V
authors.initials: AV
authors.lastname: Greco
authors.forename: Marco
authors.initials: M
authors.lastname: Castagneto
authors.forename: Geltrude
authors.initials: G
authors.lastname: Mingrone
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000009:adverse effects* / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006044:Goiter, Nodular / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D006996:Hypocalcemia / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D008286:Malabsorption Syndromes / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome