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 o...

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Bibliographic Details
Published in:Ear, nose, & throat journal nose, & throat journal, 2015-03, Vol.94 (3), p.E12-E16
Main Authors: Alfonso, Bianca, Jacobson, Adam S, Alon, Eran E, Via, Michael A
Format: Article
Language:English
Subjects:
Calcium Compounds - therapeutic use
Carcinoma, Papillary - surgery
Ergocalciferols - therapeutic use
Female
Gastric Bypass - adverse effects
Humans
Hypocalcemia - drug therapy
Hypocalcemia - etiology
Middle Aged
Risk Factors
Thyroid Neoplasms - surgery
Thyroidectomy - adverse effects
Vitamins - therapeutic use
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Summary: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.
ISSN:1942-7522