Thyroidectomy in patients who have undergone gastric bypass surgery

Goldenberg, David; Ferris, Robert L.; Shindo, Maisie L.; Shaha, Ashok R.; Stack, Brendan C.; Tufano, Ralph P.

doi:10.1002/hed.25098

Cited by 17 publications

(11 citation statements)

References 33 publications

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“…Hence, a total thyroidectomy could interfere with this compensatory process, resulting in an increased risk of postoperative primary hypoparathyroidism and hypocalcaemia [8]. Off-label treatment with teriparatide was started in our patient and resulted in stable serum calcium levels after 1 week.…”

Section: Discussionmentioning

confidence: 81%

Reversal of Roux-en-Y Gastric Bypass Fails to Facilitate the Management of Recalcitrant Hypocalcaemia Caused by Primary Hypoparathyroidism

et al. 2020

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Roux-en-Y gastric bypass (RYGB) is thought to reduce calcium absorption from the gut. Here, we report the case of a patient with a RYGB, who developed primary hypoparathyroidism after a total thyroidectomy, leading to recalcitrant hypocalcaemia. Despite aggressive oral calcium and calcitriol supplementation, she remained hypocalcaemic and required intravenous (IV) calcium supplementation to control her symptoms, and to keep calcium serum levels within an acceptable range. Teriparatide treatment improved calcium levels marginally. This treatment, however, was poorly tolerated and ultimately stopped by the patient. As a last resort, reversal of RYGB was performed to improve calciumabsorption from the gut. Unfortunately, IV calcium supplementation remained necessary. This case illustrates that the reversal of RYGB is not always a guarantee for success in managing recalcitrant hypocalcaemia.

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Section: Discussionmentioning

confidence: 81%

Reversal of Roux-en-Y Gastric Bypass Fails to Facilitate the Management of Recalcitrant Hypocalcaemia Caused by Primary Hypoparathyroidism

et al. 2020

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“…One possible explanation could be the malabsorption due to the modified anatomy of RYGB: the duodenum and the proximal jejunum have the highest concentration of calcium transporters, and are thus, the main absorption sites of calcium (28). After gastric bypass surgery, the food no longer passes through these portions of the bowel, resulting in calcium and vitamin D deficiencies (16,18).…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have reported that gastric bypass patients who undergo TT have a higher rate of recalcitrant, symptomatic hypocalcemia and increased postoperative requirements of intravenous calcium, which leads to a prolonged hospital stay (15)(16)(17)(18)(19). Different strategies have been evaluated to prevent hypocalcemia in bariatric patients undergoing TT.…”

Section: Discussionmentioning

confidence: 99%

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Is there a relationship between different types of prior bariatric surgery and post-thyroidectomy hypocalcemia?

Calì¹,

Hasani²,

Buffet³

et al. 2021

Gland Surg

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Background: Hypocalcemia is a common complication after total thyroidectomy (TT). A history of bariatric surgery has been identified as a risk factor for this complication. This study aimed to assess the risk of hypocalcemia post TT in patients with a history of obesity procedures: laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and laparoscopic gastric banding (LAGB).Methods: We compared the risk of hypocalcemia post TT (serum calcium levels <8 mg/dL) between patients with restrictive (LSG and LAGB), malabsorptive (RYGB), and patients without a history of obesity surgery. Hypoparathyroidism was considered permanent if the plasma parathyroid hormone (PTH) levels at 6 months were less than 15 pg/mL (normal range: 15-65 pg/mL) and the patient still required oral calcium (calcium carbonate) and vitamin D supplementation, in addition to the supplements that were taken routinely before thyroidectomy.Results: From the 13,242 patients who underwent TT from 2006 to 2018, 90 patients (0.7%) had a history of bariatric surgery: 35 LAGB, 29 LSG, and 26 RYGB. The risk of hypocalcemia was higher in RYGB patients (50%, n=13) than in LAGB (17.1%, n=6) or LSG patients (20.6%, n=6) (P=0.003). Furthermore, hypocalcemia risk was similar between patients with a history of restrictive procedures (18.8%, 12/64) and patients with no history of bariatric surgery (17.2%, 2,268/13,152) (P=0.4). Permanent hypoparathyroidism was observed in one and 6 patients from the LAGB and RYGB groups, respectively; however, it was not observed in any patient from the LSG group.Conclusions: RYGB is a risk factor for hypocalcemia post TT, while restrictive bariatric procedures are not.

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“…Bariatric patients who have undergone a malabsorptive operation and who later require total thyroidectomy are at additional risk for hypocalcemia. For example, RYGB has been identified as a risk factor for postoperative hypocalcemia after thyroidectomy and such management can be challenging [78,79]. Compared with patients without prior weight loss surgery, postthyroidectomy hypocalcemia in bariatric surgery patients tends to be delayed and severe, resulting in greater odds of hospitalization.…”

Section: Thyroid Cancermentioning

confidence: 99%

ASMBS position statement on the relationship between obesity and cancer, and the role of bariatric surgery: risk, timing of treatment, effects on disease biology, and qualification for surgery

Ghiassi

Chaar

Aleassa

et al. 2020

Surgery for Obesity and Related Diseases

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Thyroidectomy in patients who have undergone gastric bypass surgery

Abstract: Refractory hypocalcemia in patients who have undergone gastric bypass surgery is underreported. Careful consideration should be given to performing staged thyroidectomy and, in some cases, reversal of the bariatric surgery.

Cited by 17 publications

References 33 publications

Reversal of Roux-en-Y Gastric Bypass Fails to Facilitate the Management of Recalcitrant Hypocalcaemia Caused by Primary Hypoparathyroidism

Reversal of Roux-en-Y Gastric Bypass Fails to Facilitate the Management of Recalcitrant Hypocalcaemia Caused by Primary Hypoparathyroidism

Is there a relationship between different types of prior bariatric surgery and post-thyroidectomy hypocalcemia?

ASMBS position statement on the relationship between obesity and cancer, and the role of bariatric surgery: risk, timing of treatment, effects on disease biology, and qualification for surgery

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