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

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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)2D3), 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.

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Authors and Affiliations

  1. Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston Medical Center, 715 Albany Street, M-1013, Boston, MA, 02118-2393, USA

    Sara M. Pietras & Michael F. Holick

Authors
  1. Sara M. Pietras
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  2. Michael F. Holick
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Correspondence to Michael F. Holick.

Additional information

Disclosures  Michael F. Holick is on the Speaker’s Bureau of Merck, Proctor and Gamble, Eli Lily, and he is a consultant for Amgen, Novartis, Quest Diagnostics, Proctor and Gamble and Merck.

Sources of Support: There was no funding source for this paper.

Sara M. Pietras has nothing to declare.

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Pietras, S.M., Holick, M.F. Refractory Hypocalcemia Following Near-Total Thyroidectomy in a Patient with a Prior Roux-en-Y Gastric Bypass. OBES SURG 19, 524–526 (2009). https://doi.org/10.1007/s11695-008-9614-8

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  • DOI: https://doi.org/10.1007/s11695-008-9614-8

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