Hypocalcemia complicating near-total thyroidectomy in patients with coexisting lipid malabsorption due to biliopancreatic diversion.
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.
Manco
Melania
M
Department of Internal Medicine, CNR Centro di Fisiopatologia dello Shock, Catholic University, School of Medicine, Rome, Italy. melania.manco@rm.unicatt.it
Nanni
Giuseppe
G
Tondolo
Vincenzo
V
Iaconelli
Amerigo
A
Greco
Aldo V
AV
Castagneto
Marco
M
Mingrone
Geltrude
G
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