Previous gastric bypass surgery complicating total thyroidectomy.
Hypocalcemia is a well-known complication of total thyroidectomy. Patients who have previously undergone gastric bypass surgery may be at increased risk of hypocalcemia due to gastrointestinal malabsorption, secondary hyperparathyroidism, and an underlying vitamin D deficiency. We present the case of a 58-year-old woman who underwent a total thyroidectomy for the follicular variant of papillary thyroid carcinoma. Her history included Roux-en-Y gastric bypass surgery. Following the thyroid surgery, she developed postoperative hypocalcemia that required large doses of oral calcium carbonate (7.5 g/day), oral calcitriol (up to 4 μg/day), intravenous calcium gluconate (2.0 g/day), calcium citrate (2.0 g/day), and ergocalciferol (50,000 IU/day). Her serum calcium levels remained normal on this regimen after hospital discharge despite persistent hypoparathyroidism. Bariatric surgery patients who undergo thyroid surgery require aggressive supplementation to maintain normal serum calcium levels. Preoperative supplementation with calcium and vitamin D is strongly recommended.
Department of Endocrinology, South Miami Hospital, Miami, FL, USA.
Bianca
B
Alfonso
Adam S
AS
Jacobson
Eran E
EE
Alon
Michael A
MA
Via
D017610:Calcium Compounds / Q000627:therapeutic use; D002291:Carcinoma, Papillary / Q000601:surgery; D004872:Ergocalciferols / Q000627:therapeutic use; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D006996:Hypocalcemia / Q000188:drug therapy / Q000209:etiology*; D008875:Middle Aged; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects*; D014815:Vitamins / Q000627:therapeutic use
D017610:Calcium Compounds; D004872:Ergocalciferols; D014815:Vitamins