1
|
Guan B, Chen Y, Wu Z, Chong TH, Ming WK, Wang C, Huang S, Lee WJ, Yang J. Combined Laparoscopic Bariatric Surgery and Thyroidectomy: A Proof-of-Concept Study. Bariatr Surg Pract Patient Care 2023. [DOI: 10.1089/bari.2022.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- Bingsheng Guan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yanya Chen
- Department of Basic Nursing, School of Nursing, Jinan University, Guangzhou, China
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, China
| | - Zhenpeng Wu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tsz Hong Chong
- Department of Thyroid Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wai-kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, China
| | - Cunchuan Wang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shifang Huang
- Department of Intensive Care Unit, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan, China
| | - Jingge Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| |
Collapse
|
2
|
Cleere EF, Davey MG, Crotty TJ, Young O, Lowery AJ, Kerin MJ. Hypocalcaemia following thyroidectomy among patients who have previously undergone bariatric surgery: systematic review and meta-analysis. Br J Surg 2022; 109:1198-1205. [PMID: 36047335 DOI: 10.1093/bjs/znac310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/18/2022] [Accepted: 08/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hypocalcaemia is a common complication after thyroidectomy. Bariatric surgery is associated with significant changes in calcium metabolism. Some studies have identified bariatric surgery as a risk factor for hypocalcaemia after thyroidectomy. This systematic review and meta-analysis assessed whether a history of bariatric surgery was associated with an increased risk of hypocalcaemia after thyroidectomy. METHODS This prospectively registered systematic review (PROSPERO; CRD42021295423) was performed in accordance with PRISMA guidelines. Meta-analysis was undertaken using the Mantel-Haenszel method, with outcomes reported as ORs with 95 per cent confidence intervals. RESULTS Twenty studies were included in the qualitative synthesis. Five studies incorporating 19 547 patients met the inclusion criteria for meta-analysis, of whom 196 (1.0 per cent) had a history of bariatric surgery. Patients with a history of bariatric surgery were more likely to develop hypocalcaemia after thyroidectomy (30.6 versus 13.0 per cent; OR 3.90, 95 per cent c.i. 1.50 to 10.12; P = 0.005). Among those with a history of bariatric surgery, patients who underwent a bypass procedure were more likely to develop hypocalcaemia after thyroidectomy than those who had a restrictive procedure (38 versus 23 per cent; OR 2.12, 1.14 to 3.97; P = 0.020). CONCLUSION Patients with a history of bariatric surgery have a significantly greater risk of hypocalcaemia after thyroidectomy, with a heightened risk among those who have had a bypass procedure. Surgeons performing thyroid surgery should be aware of the increased risk of hypocalcaemia after thyroidectomy among these patients.
Collapse
Affiliation(s)
- Eoin F Cleere
- Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
- Department of Otolaryngology Head and Neck surgery, Galway University Hospital, Galway, Ireland
| | - Matthew G Davey
- Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
| | - Thomas J Crotty
- Department of Otolaryngology Head and Neck surgery, Galway University Hospital, Galway, Ireland
| | - Orla Young
- Department of Otolaryngology Head and Neck surgery, Galway University Hospital, Galway, Ireland
| | - Aoife J Lowery
- Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
- Department of Breast and Endocrine surgery, Galway University Hospital, Galway, Ireland
| | - Michael J Kerin
- Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
- Department of Breast and Endocrine surgery, Galway University Hospital, Galway, Ireland
| |
Collapse
|
3
|
Duran İD, Gülçelik NE, Bulut B, Balcı Z, Berker D, Güler S. Differences in Calcium Metabolism and Thyroid Physiology After Sleeve Gastrectomy and Roux-En-Y Gastric Bypass. Obes Surg 2019; 29:705-712. [PMID: 30460439 DOI: 10.1007/s11695-018-3595-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Bariatric surgery may modulate the hormones and elements which maintain thyroid and calcium homeostasis. These adaptations in hormonal and elemental aspects have previously been determined via some studies with variations in their findings. Thyroid volume and 24-h urinary calcium are two parameters which have not been investigated regarding whether they change during the bariatric postsurgical period. This study planned to examine the changes in calcium metabolism and thyroid gland functioning after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS Seventy-three morbidly obese patients with planned bariatric surgery were enrolled in the study. Before and 12 months after the operation, parathormone (PTH), 25-OH-vitamin D3(25vitD3), TSH, free triiodothyronine (fT3), free thyroxine (fT4), calcium (Ca), 24-h urinary Ca and ultrasonography-guided thyroid volume were measured. RESULTS In the beginning, 73 patients were examined and 12 months after surgery out of 25 patients continuing follow-up, 20 (80%) had undergone sleeve gastrectomy (SG) while five (20%) had undergone Roux-en-Y gastric bypass (RYGB). Accompanied by significant BMI decrease, 24-h urinary Ca and thyroid volume did not significantly increase in RYGB, SG, and the whole group after 12 months. The SG group showed a significant drop in TSH (p 0.03) level, while the RYGB group showed significant decreases in fT4 (p 0.00) and fT3 (p 0.00); and significant fT3 decrease (p 0.01) was recorded for the whole group. CONCLUSION Bariatric surgery may modify Ca homeostasis and thyroid gland functional status. We documented that these were not statistically significant increases in 24-h urinary Ca level and thyroid volume after 1 year. Further studies are needed to understand the issue, enrolling more patients who underwent the same bariatric procedure and after accounting for the inhibition of supplementary vitamin and mineral effects.
Collapse
Affiliation(s)
- İffet Dağdelen Duran
- Ankara Numune Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, TC. Sağlık Bakanlığı, Ankara, Turkey.
| | - Neşe Ersöz Gülçelik
- Ankara Gülhane Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, TC. Sağlık Bakanlığı, Ankara, Turkey
| | - Bekir Bulut
- Ankara Numune Education and Research Hospital, Department of General Surgery, TC. Sağlık Bakanlığı, Ankara, Turkey
| | - Zeynep Balcı
- Ankara Numune Education and Research Hospital, Department of General Surgery, TC. Sağlık Bakanlığı, Ankara, Turkey
| | - Dilek Berker
- Ankara Numune Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, TC. Sağlık Bakanlığı, Ankara, Turkey
| | - Serdar Güler
- Ankara Numune Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, TC. Sağlık Bakanlığı, Ankara, Turkey
| |
Collapse
|
4
|
Spartalis E, Thanassa A, Athanasiadis DI, Schizas D, Athanasiou A, Zografos GN, Tsourouflis G, Dimitroulis D, Nikiteas N. Post-thyroidectomy Hypocalcemia in Patients With History of Bariatric Operations: Current Evidence and Management Options. In Vivo 2019; 33:1373-1379. [PMID: 31280233 DOI: 10.21873/invivo.11614] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/08/2019] [Accepted: 06/10/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIM Both bariatric and thyroid surgeries promote calcium and vitamin D deficiency. The correlation, however, of hypocalcemia after thyroidectomy in patients with previous bariatric surgery has been poorly described. This review aimed to investigate the relationship between history of bariatric operations and post-thyroidectomy hypocalcemia, as well as suggested management options. MATERIALS AND METHODS MEDLINE and Cochrane databases were searched for relevant publications regarding post-thyroidectomy hypocalcemia in patients with previous bariatric surgery. RESULTS A total of 17 publications reporting on 126 patients met the inclusion criteria. These included 13 publications about Roux-en-Y gastric bypass (RYGB), 2 regarding biliopancreatic diversion (BPD), 1 about sleeve gastrectomy (SG) and 1 compared three bariatric procedures: SG, RYGB, laparoscopic adjustable gastric band (LAGB). Post-thyroidectomy hypocalcemia was found to be more prevalent in patients with previous RYGB and BPD, but not in previous LAGB and SG. CONCLUSION Patients with previous bariatric surgery are at high risk of post-thyroidectomy hypocalcemia that sometimes leads to higher length of hospital stay and demands more invasive solutions. There is a need, however, for additional studies and further investigation in order to reach more conclusive results.
Collapse
Affiliation(s)
- Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Medical School, Athens, Greece .,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| | - Antonia Thanassa
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,Third Department of Surgery, Athens General Hospital "Georgios Gennimatas", Athens, Greece
| | | | - Dimitrios Schizas
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,1st Department of Surgery, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Antonios Athanasiou
- Department of Upper GI, Bariatric & Minimally invasive Surgery, St. James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, U.K
| | - Georgios N Zografos
- Third Department of Surgery, Athens General Hospital "Georgios Gennimatas", Athens, Greece
| | - Gerasimos Tsourouflis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nikolaos Nikiteas
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| |
Collapse
|
5
|
Goldenberg D, Ferris RL, Shindo ML, Shaha A, Stack B, Tufano RP. Thyroidectomy in patients who have undergone gastric bypass surgery. Head Neck 2018; 40:1237-1244. [DOI: 10.1002/hed.25098] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/11/2017] [Accepted: 01/11/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- David Goldenberg
- Department of Surgery; The Pennsylvania State University, College of Medicine; Hershey Pennsylvania
| | - Robert L. Ferris
- Division of Head and Neck Surgery; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Maisie L. Shindo
- Department of Otolaryngology; Oregon Health and Science University; Portland Oregon
| | - Ashok Shaha
- Department of Head and Neck Services; Memorial Sloan Kettering Cancer Center; New York New York
| | - Brendan Stack
- Department of Head and Neck Surgery; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Ralph P. Tufano
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland
| |
Collapse
|
6
|
De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, Sartori A, Stier C, Lakdawala M, Bhasker AG, Buchwald H, Dixon J, Chiappetta S, Kolberg HC, Frühbeck G, Sarwer DB, Suter M, Soricelli E, Blüher M, Vilallonga R, Sharma A, Shikora S. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2016; 26:1659-96. [PMID: 27412673 PMCID: PMC6037181 DOI: 10.1007/s11695-016-2271-4] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maurizio De Luca
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy.
| | | | - Jacques Himpens
- The European School of Laparoscopic Surgery, Brussels, Belgium
| | | | | | | | - Alberto Sartori
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy
| | | | | | | | | | - John Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Michel Suter
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mattias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Arya Sharma
- Obesity Research Management, University of Alberta, Edmonton, Canada
| | | |
Collapse
|
7
|
Lipids and bariatric procedures Part 2 of 2: scientific statement from the American Society for Metabolic and Bariatric Surgery (ASMBS), the National Lipid Association (NLA), and Obesity Medicine Association (OMA) 1. Surg Obes Relat Dis 2016; 12:468-495. [DOI: 10.1016/j.soard.2016.01.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 12/17/2022]
|
8
|
Gooi Z, Ward BK, Mener DJ, Ozgursoy OB, Pai SI. A staged thyroidectomy approach for gastric bypass patients. Laryngoscope 2014; 125:1028-30. [DOI: 10.1002/lary.24835] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 06/04/2014] [Accepted: 06/23/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Zhen Gooi
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
| | - Bryan K. Ward
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
| | - David J. Mener
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
| | - Ozan B. Ozgursoy
- Department of Otolaryngology-Head and Neck Surgery; Ankara University Medical School; Ankara Turkey
| | - Sara I. Pai
- Division of Laryngeal Surgery; Department of Surgery; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts U.S.A
| |
Collapse
|
9
|
Life-Threatening Hypocalcemia following Subtotal Parathyroidectomy in a Patient with Renal Failure and Previous Roux-en-Y Gastric Bypass Surgery. Case Rep Endocrinol 2011; 2011:370583. [PMID: 22937282 PMCID: PMC3420727 DOI: 10.1155/2011/370583] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 10/02/2011] [Indexed: 01/14/2023] Open
Abstract
Background. Roux-en-Y gastric bypass (RYGB) can result in calcium and vitamin D deficiency. Parathyroid surgery carries the risk of immediate and long-term hypocalcemia. Methods and Results. We describe a 54-year-old woman with history of end-stage renal disease and gastric bypass surgery who developed calciphylaxis requiring a 3.5-gland parathyroidectomy. Seven weeks later, she presented with weakness, perioral numbness, leg cramps, a positive Chvostek's sign, hypotension, prolonged QT-interval, and serum calcium of 5.4 mg/dL. Oral and intravenous calcium, calcitriol, and high calcium bath hemodialysis were given. She required 18 days of intravenous calcium and an outpatient maintenance regimen of calcitriol 6 mcg/day, calcium carbonate 8 grams/day, calcium citrate 1.2 grams/day, and ergocalciferol 50,000 IU/week. Conclusion. The patient's life-threatening prolonged hypocalcemia and large requirements of calcium and calcitriol were due to a combination of malabsorption, hypoparathyroidism, and renal failure. Special considerations should be given to bariatric surgery patients undergoing neck exploration.
Collapse
|
10
|
Kini S, Kannan U. Effect of bariatric surgery on future general surgical procedures. J Minim Access Surg 2011; 7:126-31. [PMID: 21523234 PMCID: PMC3078474 DOI: 10.4103/0972-9941.78342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 09/20/2011] [Indexed: 11/18/2022] Open
Abstract
Bariatric surgery is now accepted as a safe and effective procedure for morbid obesity. The frequency of bariatric procedures is increasing with the adoption of the laparoscopic approach. The general surgeons will be facing many more of such patients presenting with common general surgical problems. Many of the general surgeons, faced with such situations, may not be aware of the changes in the gastrointestinal anatomy following bariatric procedures and management of these clinical situations will therefore present diagnostic and therapeutic challenges. We hereby present a review of management of few common general surgical problems in patients with a history of bariatric surgery.
Collapse
Affiliation(s)
- Subhash Kini
- Metabolic, Endocrine and Minimally Invasive Surgery, Mount Sinai School of Medicine, New York, USA
| | | |
Collapse
|
11
|
Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J, Guven S. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring) 2009; 17 Suppl 1:S1-70, v. [PMID: 19319140 DOI: 10.1038/oby.2009.28] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health-care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.
Collapse
|
12
|
Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract 2008; 14 Suppl 1:1-83. [PMID: 18723418 DOI: 10.4158/ep.14.s1.1] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
13
|
Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis 2008; 4:S109-84. [PMID: 18848315 DOI: 10.1016/j.soard.2008.08.009] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist healthcare professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.
Collapse
|
14
|
Pietras SM, Holick MF. Refractory hypocalcemia following near-total thyroidectomy in a patient with a prior Roux-en-Y gastric bypass. Obes Surg 2008; 19:524-6. [PMID: 18592328 DOI: 10.1007/s11695-008-9614-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 06/04/2008] [Indexed: 01/27/2023]
Abstract
Patients undergoing malabsorptive weight-loss procedures are at increased risk of calcium and vitamin D deficiency. Thyroidectomy carries the risk of both immediate and long-term hypocalcemia. Here we describe a patient who underwent Roux-en-Y gastric bypass (RYGB) and subsequent near-total thyroidectomy and then developed refractory hypocalcemia. Serum calcium reached a nadir of 6.1 mg/dl despite aggressive therapy with oral and IV calcium, calcitriol (1,25(OH)(2)D(3)), and IV magnesium sulfate. One year later, the patient has permanent hypoparathyroidism and requires very high doses of calcium, vitamin D, and calcitriol to prevent symptomatic hypocalcemia. Providers should be aware that malabsorption of calcium and vitamin D after RYGB may complicate patient management after thyroidectomy.
Collapse
Affiliation(s)
- Sara M Pietras
- Boston University School of Medicine, Boston Medical Center, Boston, MA 02118-2393, USA
| | | |
Collapse
|
15
|
Need for multivitamin use in the postoperative period of gastric bypass. Obes Surg 2007; 18:187-91. [PMID: 18163192 DOI: 10.1007/s11695-007-9384-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Accepted: 11/28/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Based on the reduced gastric volume and the malabsorption produced by Roux-en-Y gastric bypass (RYGBP) and diet therapy, it is essential in the postoperative period to obtain and maintain an adequate nutritional state, with the aim of preventing malnutrition and seeking a healthy life. It is observed that patients have difficulty in understanding the new food choices that must considered, as they have eating habits that are very divergent from those currently proposed. There is often the need for vitamin and mineral replacement after laboratory tests. METHODS This study calculated and evaluated the 24-h eating records of 210 patients, collected in the course of nutritional visits in follow-ups of the first, third, sixth, ninth, 12th, 18th, and 24th months postoperative. RESULTS It was possible to observe an increase in the consumption of nutrients in the course of the study period, but it was not regular and significant for all the nutrients. Also, it is noted that the minimal requirements for vitamin A, vitamin C, calcium, iron and B-complex vitamins (except for cyanocobalamin and riboflavin) were not attained. The nutrients in which satisfactory results were obtained were total proteins of high biological value: cyanocobalamin and riboflavin. CONCLUSION This study demonstrated the concern for nutrient supplementation in the postoperative period of RYGBP. Thus, the routine use of multivitamins is deemed necessary after the first month postoperatively, with its maintenance preferably for the rest of the patient's life, without abandoning periodic clinical and laboratory follow-up.
Collapse
|
16
|
Harzallah F, Daoud I, Bouzid C, Oueslati A, Kanoun F, Slimane H. [Celiac disease revealed by hypocalcemia complicating total thyroidectomy: a case report]. ANNALES D'ENDOCRINOLOGIE 2006; 67:357-9. [PMID: 17072243 DOI: 10.1016/s0003-4266(06)72612-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In order to illustrate a particular circumstance of diagnosis of celiac disease, we report the case of 54-year-old women with a history of thyroid enlargement with normal thyroid function and positive anti-peroxidase antibodies. Immediately after total thyroidectomy with preservation of the parathyroid glands, she developed tetany with total serum calcium level at 50mg/l. Intravenous calcium infusion increased the calcium level and led to resolution of hypocalcemia-induced signs but there was no result when calcium and vitamin D were taken orally. The diagnosis of malabsorption was very probable in light of the family history of celiac disease, the anemia and the hypoalbuminemia. The diagnosis was confirmed by antibodies assay and endoscopy. The PTH level was less than 1 pg/l and radiography showed signs of hyperparathyroidism. Gluten-free diet, calcium and vitamin D led to an improvement of serum calcium.
Collapse
Affiliation(s)
- F Harzallah
- Service Endocrinologie-Diabétologie, Hôpital La Rabta, 1007 Tunis, Tunisia
| | | | | | | | | | | |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW Bariatric surgery is being increasingly used to help treat morbidly obese adults and adolescents. As a greater percentage of this population faces a lifetime of living with surgically altered gastrointestinal anatomy and physiology, increased awareness of the nutritional consequences is critical for all health care practitioners, as many of these patients may be lost to follow-up and can present with significant nutritional complications years after surgery. RECENT FINDINGS Nutritional deficiencies can occur after bariatric surgery, although to a lesser degree after restrictive procedures. Risk may increase over time, perhaps due to poor compliance with supplementation, continued inadequate intake and/or ongoing malabsorption. Adolescent patients may be at greater risk due to poor compliance and longer life span. Nutritional monitoring and supplementation among bariatric programs has been widely variable and few prospective studies of outcomes exist. SUMMARY Bariatric surgery can carry significant risk of nutritional complications. Compliance with dietary recommendations should be monitored and encouraged, with annual screening for selected deficiencies. Prospective longitudinal research is needed to identify the true prevalence and significance of nutritional deficiency in these patients and to determine optimum dietary recommendations.
Collapse
Affiliation(s)
- Stavra A Xanthakos
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Ohio 45229-3039, USA.
| | | |
Collapse
|