Severe Hypocalcemia following Total Thyroidectomy after Biliopancreatic Diversion

Abstract

Patients undergoing malabsoprtive operations for bariatric surgery are prone to disturbances of bone metabolism, but this does not commonly lead to clinical symptoms. We present a morbidly obese patient who had undergone the biliopancreatic diversion of Larrad, and presented clinical symptoms of severe hypocalcemia and tetany after total thyroidectomy. Very high doses of i.v. calcium and calcitriol and 10 days of hospitalization were required to control the symptoms and correct plasma levels. The physiological aspects that contribute to this situation are discussed.

Refractory Hypocalcemia Following Near-Total Thyroidectomy in a Patient with a Prior Roux-en-Y Gastric Bypass

“…To our knowledge, others have reported hypocalcemia following thyroidectomy in patients with previous biliopancreatic diversion (BPD) [3,4]. However, we do not know of any reports of a similar problem after RYGB, which is a procedure that generally bypasses less of the small intestine when compared to BPD [5].…”

Need for Multivitamin Use in the Postoperative Period of Gastric Bypass

“…The malabsorption of vitamin D interferes in the absorption of calcium and stimulates hyperparathyroidism, which in the long term leads to the occurrence of osteoporosis [11,29,31,32]. In this study, calcium deficiency was observed in the diet, and in clinical practice, the above systemic damage is encountered [10,24,29,31,32].…”

“…Studies have demonstrated that patients in the postoperative period of bariatric surgery show abnormalities in bone mass, showing hypocalcemia in as many as 15% to 48% of patients [10,29,30]. Moreover, the deficient absorption of lipid-soluble vitamins (vitamins A, E, D, and K) aggravate the malabsorption of calcium [5,6,10,19,25,29,30]. The malabsorption of vitamin D interferes in the absorption of calcium and stimulates hyperparathyroidism, which in the long term leads to the occurrence of osteoporosis [11,29,31,32].…”

“…Currently, the most variable degrees of medium-and long-term nutritional deficiencies are observed in these patients. This is the greatest concern of the healthcare professionals involved in this treatment [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Nutritional consequences of bariatric surgery

“…Severe, symptomatic hypocalcemia has emerged years after BPD, triggered by total thyroidectomy for papillary cancer [54,55].…”