Skip to main content

Advertisement

SpringerLink
Log in

Hypocalcemia after parathyroidectomy in patients with a history of bariatric surgery

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Purpose

A growing body of literature has suggested that a history of bariatric surgery increases the risk of hypocalcemia after subsequent thyroidectomy, however little is known about the risk after parathyroidectomy. The purpose of this study was to determine the incidence of hypocalcemia after parathyroidectomy in patients with prior bariatric surgery.

Methods

The TriNetX Research Network was queried using diagnosis and procedure codes to identify patients with a history of bariatric surgery who were subsequently diagnosed with primary hyperparathyroidism (PHP) and underwent parathyroidectomy between 2012 and 2022. The rate of hypocalcemia after parathyroidectomy was compared between those with a history of bariatric surgery and controls who underwent parathyroidectomy alone, matched for demographics, body mass index (BMI) ≥ 30 kg/m2, and history of calcium or vitamin D supplementation.

Results

There were 34,483 included patients diagnosed with PHP who underwent parathyroidectomy. Of this cohort, 1.4% (n = 472) had prior bariatric surgery. There were 90% females and 10% males in this subset of patients, and the average age was 58 years. Compared to matched controls who underwent parathyroidectomy alone, these patients had a significantly increased risk of hypocalcemia within 0–1 month (RR, 95% CI, P) (17.2% vs. 9.3%; 1.8, 1.3–2.6, P < 0.001), 1–6 months (8.5% vs. 2.5%; 3.3, 1.8–6.3, P < 0.001) and 6–12 months (6.8% vs. 2.3%; 2.9, 1.5–5.7, P < 0.001) following surgery.

Conclusion

The current study is the first to indicate that patients with a history of bariatric surgery are at increased risk for short-term and permanent hypocalcemia after parathyroidectomy. Further research is required to determine optimal prevention and treatment strategies to decrease associated morbidity in this subset of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. F.X. Pi-Sunyer, Health implications of obesity. Am. J. Clin. Nutr. 53, 1595S–1603S (1991). https://doi.org/10.1093/ajcn/53.6.1595S

    Article  CAS  PubMed  Google Scholar 

  2. Y.C. Chooi, C. Ding, F. Magkos, The epidemiology of obesity. Metabolism 92, 6–10 (2019). https://doi.org/10.1016/j.metabol.2018.09.005

    Article  CAS  PubMed  Google Scholar 

  3. H.J. Kissler, U. Settmacher, Bariatric surgery to treat obesity. Semin. Nephrol. 33, 75–89 (2013). https://doi.org/10.1016/j.semnephrol.2012.12.004

    Article  PubMed  Google Scholar 

  4. M.S. Altieri, W. Irish, W.J. Pories, A. Shah, E.J. DeMaria, Examining the rates of obesity and bariatric surgery in the United States. Obes. Surg. 31, 4754–4760 (2021). https://doi.org/10.1007/s11695-021-05628-y

    Article  PubMed  Google Scholar 

  5. C. Karefylakis, I. Näslund, D. Edholm, M. Sundbom, F.A. Karlsson, E. Rask, Vitamin D status 10 years after primary gastric bypass: gravely high prevalence of hypovitaminosis D and raised PTH levels. Obes. Surg. 24, 343–348 (2014). https://doi.org/10.1007/s11695-013-1104-y

    Article  PubMed  Google Scholar 

  6. R.D. Bloomberg, A. Fleishman, J.E. Nalle, D.M. Herron, S. Kini, Nutritional deficiencies following bariatric surgery: what have we learned. Obes. Surg. 15, 145–154 (2005). https://doi.org/10.1381/0960892053268264

    Article  PubMed  Google Scholar 

  7. J. Johnson, J. Maher, I. Samuel, D. Heitshusen, C. Doherty, R. Downs, Effects of gastric bypass procedures on bone mineral density, calcium, parathyroid hormone, and vitamin D. J. Gastrointest. Surg. 9, 1106–1111 (2005). https://doi.org/10.1016/j.gassur.2005.07.012

    Article  PubMed  Google Scholar 

  8. J. Ponce, N.T. Nguyen, M. Hutter, R. Sudan, J.M. Morton, American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in the United States, 2011-2014. Surg. Obes. Relat. Dis. 11, 1199–1200 (2015). https://doi.org/10.1016/j.soard.2015.08.496

    Article  PubMed  Google Scholar 

  9. Monte, L., Tuccinardi, D., Strollo, R., Briganti, S., Rausa, D., Pozzilli, P., Napoli, N., Manfrini, S.: Primary hyperparathyroidism in the setting of previous roux-en-Y gastric bypass: a case report. Endocr. Abstr. (2022). https://doi.org/10.1530/endoabs.81.EP191

  10. Y. Chen, C.C. Lubitz, S.A. Shikora, R.A. Hodin, R.D. Gaz, F.D. Moore, T.J. McKenzie, Primary hyperparathyroidism after Roux-en-Y gastric bypass. Obes. Surg. 25, 700–704 (2015). https://doi.org/10.1007/s11695-014-1444-2

    Article  PubMed  Google Scholar 

  11. E. Silverman, I. Bernstein, P. Akkireddy, Abstract #1003673: normocalcemic primary hyperparathyroidism post bariatric surgery. Endocr. Pract. 27, S99–S100 (2021). https://doi.org/10.1016/j.eprac.2021.04.679

    Article  Google Scholar 

  12. M. Haueisen Sander Diniz, F. de, A.M.R. Beleigoli, A.L. Savassi-Rocha, S.R. de Almeida Sanches, M.T.C. Diniz, Letter: primary hyperparathyroidism after Roux-en-Y gastric bypass. Obes. Surg. 26, 861–861 (2016). https://doi.org/10.1007/s11695-016-2053-z

    Article  PubMed  Google Scholar 

  13. M. Keskin, D. Öztürk, A. Or Koca, D.T. Ertuğrul, H. Bulus, Does bariatric surgery increase the formation of parathyroid adenoma. Bariatr. Surg. Pract. Patient Care. 15, 155–159 (2020). https://doi.org/10.1089/bari.2019.0043

    Article  Google Scholar 

  14. K. Lorenz, J. Hein, H. Dralle, Primärer hyperparathyreoidismus nach adipositaschirurgie. Der Chir. 85, 1110–1110 (2014). https://doi.org/10.1007/s00104-014-2908-6

    Article  CAS  Google Scholar 

  15. E. Spartalis, A. Thanassa, D.I. Athanasiadis, D. Schizas, A. Athanasiou, G.N. Zografos, G. Tsourouflis, N. Nikiteas, Post-thyroidectomy hypocalcemia in patients with history of bariatric operations: current evidence and management options. Vivo (Brooklyn) 33, 1373–1379 (2019). https://doi.org/10.21873/invivo.11614

    Article  CAS  Google Scholar 

  16. D. Goldenberg, R.L. Ferris, M.L. Shindo, A. Shaha, B. Stack, R.P. Tufano, Thyroidectomy in patients who have undergone gastric bypass surgery. Head. Neck 40, 1237–1244 (2018). https://doi.org/10.1002/hed.25098

    Article  PubMed  Google Scholar 

  17. Lorenz, F.J., Tucker, J., Milarachi, E.N., Hearn, M., King, T.S., Goldenberg, D.: Hypocalcemia after Thyroidectomy in Patients with Prior Bariatric Surgery: A Propensity Score Matched Analysis from a National Administrative Database. Thyroid. (2022). https://doi.org/10.1089/thy.2022.0312

  18. Topaloglu, U., Palchuk, M.B.: Using a Federated Network of Real-World Data to Optimize Clinical Trials Operations. JCO Clin. Cancer Informatics. 1–10 (2018). https://doi.org/10.1200/CCI.17.00067

  19. Goltzman, D.: Etiology of hypocalcemia in adults. In: Rosen, C.J. and Mulder, J.E. (eds.) UptoDate (2021)

  20. L.F. Remer, S.M. Linhares, W.H. Scola, Z.F. Khan, J.I. Lew, Transient hypocalcemia after total thyroidectomy: the obesity paradox at work? J. Surg. Res. 278, 93–99 (2022). https://doi.org/10.1016/j.jss.2022.04.048

    Article  PubMed  Google Scholar 

  21. W.P.T. James, WHO recognition of the global obesity epidemic. Int. J. Obes. 32, S120–S126 (2008). https://doi.org/10.1038/ijo.2008.247

    Article  Google Scholar 

  22. O. Kaidar-Person, B. Person, S. Szomstein, R.J. Rosenthal, Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? part B: minerals. Obes. Surg. 18, 1028–1034 (2008). https://doi.org/10.1007/s11695-007-9350-5

    Article  PubMed  Google Scholar 

  23. Kaidar-Person, O., Person, B., Szomstein, S., Rosenthal, R.J.: Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? part A: vitamins. Obes. Surg. (2008). https://doi.org/10.1007/s11695-008-9563-2

  24. J.S. Walsh, S. Bowles, A.L. Evans, Vitamin D in obesity. Curr. Opin. Endocrinol. Diabetes Obes. 24, 389–394 (2017). https://doi.org/10.1097/MED.0000000000000371

    Article  CAS  PubMed  Google Scholar 

  25. J.-H. Wei, W.-J. Lee, K. Chong, Y.-C. Lee, S.-C. Chen, P.-H. Huang, S.-J. Lin, High incidence of secondary hyperparathyroidism in bariatric patients: comparing different procedures. Obes. Surg. 28, 798–804 (2018). https://doi.org/10.1007/s11695-017-2932-y

    Article  PubMed  Google Scholar 

  26. J. Jin, A.V. Robinson, P.T. Hallowell, J.J. Jasper, T.A. Stellato, S.M. Wilhem, Increases in parathyroid hormone (PTH) after gastric bypass surgery appear to be of a secondary nature. Surgery 142, 914–920 (2007). https://doi.org/10.1016/j.surg.2007.09.023

    Article  PubMed  Google Scholar 

  27. D.V. Avgerinos, M.I. Leitman, R.E. Martínez, P.E. Liao, Evaluation of markers for calcium homeostasis in a population of obese adults undergoing gastric bypass operations. J. Am. Coll. Surg. 205, 294–297 (2007). https://doi.org/10.1016/j.jamcollsurg.2007.02.078

    Article  PubMed  Google Scholar 

  28. J.M. Johnson, J.W. Maher, E.J. DeMaria, R.W. Downs, L.G. Wolfe, J.M. Kellum, The long-term effects of gastric bypass on vitamin D metabolism. Ann. Surg. 243, 701–704 (2006). https://doi.org/10.1097/01.sla.0000216773.47825.c1. discussion 704-5

    Article  PubMed  PubMed Central  Google Scholar 

  29. B. Palal, M. Sinsakul, S. Reutrakul, Life-threatening hypocalcemia following subtotal parathyroidectomy in a patient with renal failure and previous roux-en-y gastric bypass surgery. Case Rep. Endocrinol. 2011, 370583 (2011). https://doi.org/10.1155/2011/370583

    Article  PubMed  PubMed Central  Google Scholar 

  30. S.M. Wilhelm, T.S. Wang, D.T. Ruan, J.A. Lee, S.L. Asa, Q.-Y. Duh, G.M. Doherty, M.F. Herrera, J.L. Pasieka, N.D. Perrier, S.J. Silverberg, C.C. Solórzano, C. Sturgeon, M.E. Tublin, R. Udelsman, S.E. Carty, The American association of endocrine surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 151, 959 (2016). https://doi.org/10.1001/jamasurg.2016.2310

    Article  PubMed  Google Scholar 

  31. J.A. Harvey, M.M. Zobitz, C.Y.C. Pak, Dose dependency of calcium absorption: A comparison of calcium carbonate and calcium citrate. J. Bone Miner. Res 3, 253–258 (2009). https://doi.org/10.1002/jbmr.5650030303

    Article  Google Scholar 

  32. B. Cali, A. Hasani, C. Buffet, F. Menegaux, N. Chereau, Is there a relationship between different types of prior bariatric surgery and post-thyroidectomy hypocalcemia. Gland Surg. 10, 2088–2094 (2021). https://doi.org/10.21037/gs-21-225

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by F.J.L. The first draft of the manuscript was written by F.J.L. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Funding

The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through Grant UL1 TR002014. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. College of Medicine, The Pennsylvania State University, Hershey, PA, USA

    F. Jeffrey Lorenz

  2. Department of Otolaryngology–Head and Neck Surgery, Penn State College of Medicine, Hershey, PA, USA

    David Goldenberg

Authors
  1. F. Jeffrey Lorenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Goldenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Goldenberg.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethical approval

This is an observational study. The Penn State Institutional Review Board reviewed and approved STUDY00018629 as exempt according to institutional policies and applicable federal regulations.

Consent to participate

This is an observational study. Any data displayed on the TriNetX platform in aggregate form, or any patient level data provided in a data set generated by the TriNetX platform, only contains de-identified data. Therefore, the need for informed consent was waived.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lorenz, F.J., Goldenberg, D. Hypocalcemia after parathyroidectomy in patients with a history of bariatric surgery. Endocrine 79, 571–576 (2023). https://doi.org/10.1007/s12020-022-03234-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-022-03234-1

Keywords

Search

Navigation