title: Recalcitrant hypocalcemia after thyroidectomy in patients with previous Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Hypocalcemia is a potential complication after thyroidectomy. Patients with previous roux-en-Y gastric bypass (RYGBP) may be at increased risk for recalcitrant symptomatic hypocalcemia after thyroidectomy. This complication is poorly described and there is no current consensus on optimal management in this unique population.
  
  
  METHODS
  All patients from 2000 to 2012 who underwent thyroidectomy with history of preceding RYGBP were identified retrospectively. Each of the 19 patients meeting inclusion criteria were matched 2:1 for age, gender, and body mass index (BMI) to a cohort who underwent thyroidectomy without previous RYGBP. The study cohort and matched controls were compared for incidence of symptomatic postoperative hypocalcemia, requirement of intravenous (IV) calcium supplementation, and duration of hospital stay.
  
  
  RESULTS
  Age, proportion of female patients, and BMI were equivalent between cases (n = 19) and controls (n = 38). Comparison of primary outcomes demonstrated that the study group had a significantly higher incidence of symptomatic hypocalcemia (42% vs. 0%; P < .01), administration of IV calcium (21% vs. 0%; P < .01), and duration of hospital stay (2.2 vs. 1.2 days, P = .02).
  
  
  CONCLUSIONS
  Patients with previous RYGBP have a greater incidence of recalcitrant symptomatic hypocalcemia after thyroidectomy, resulting in prolonged duration of hospital stay. In this patient population, calcium levels should be closely monitored and early calcium and vitamin D supplementation initiated preemptively.
authors: Massachusetts General Hospital, Department of Surgery, Wang Ambulatory Care Center, Boston, MA. Electronic address: tjmckenzie@partners.org.
authors: Travis J
authors: TJ
authors: McKenzie
authors: Yufei
authors: Y
authors: Chen
authors: Richard A
authors: RA
authors: Hodin
authors: Scott A
authors: SA
authors: Shikora
authors: Matthew M
authors: MM
authors: Hutter
authors: Randall D
authors: RD
authors: Gaz
authors: Francis D
authors: FD
authors: Moore
authors: Carrie C
authors: CC
authors: Lubitz
mesh_terms: D000328:Adult; D002118:Calcium / Q000008:administration & dosage / Q000097:blood; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013965:Thyroidectomy / Q000009:adverse effects*; D014807:Vitamin D / Q000008:administration & dosage / Q000097:blood
chemical_list: C470125:PTH protein, human; D010281:Parathyroid Hormone; D014807:Vitamin D; D002118:Calcium
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