Recalcitrant hypocalcaemia in a patient with post-thyroidectomy hypoparathyroidism and Roux-en-Y gastric bypass

Miguel, Gonzalo Allo; Fernández, Elena; Díaz-Guerra, Guillermo Martínez; Zanuy, María Angeles Valero; Zapata, Ana Pérez; Vigo, Felipe de la Cruz; Carranza, Federico Hawkins

doi:10.1016/j.orcp.2015.09.001

Cited by 17 publications

(13 citation statements)

References 18 publications

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“…After the failure of IV administration of calcium, a gastrostomy (G-tube) was placed in order to deliver calcium and other nutrients through the excluded stomach and the duodenum. That initiative led to an Allo Miguel et al (19) have reported the use of teriparatide in their patient who underwent thyroid surgery after a bariatric procedure but the response was not satisfactory and they reversed RYGB.…”

Section: Resultsmentioning

confidence: 99%

Post-thyroidectomy Hypocalcemia in Patients With History of Bariatric Operations: Current Evidence and Management Options

Spartalis

Thanassa²,

Athanasiadis

et al. 2019

In Vivo

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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 postthyroidectomy 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. Obesity has become a common health problem in western countries (1) and bariatric surgery is one of the most effective therapies for these patients. This procedure reduces the metabolic risk factors in morbidly obese patients and directly results in adequate weight loss. The most popular bariatric surgeries are Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), biliopancreatic diversion (BPD) and laparoscopic adjustable gastric band (LAGB) (2, 3). Sleeve gastrectomy and the adjustable gastric band are restrictive procedures while the other two are malabsorptive ones. Although very advantageous, bariatric surgery causes vitamin and mineral deficiencies, including that of calcium and vitamin D, leading to hypocalcemia (4). On the other hand, hypocalcemia is a common complication of thyroid surgery (5). Thus, as the number of post-gastric bypass patients increases, it is expected that an increased number of patients will be diagnosed with thyroid pathology requiring thyroid surgery. This combination of a 1373 This article is freely accessible online.

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Section: Resultsmentioning

confidence: 99%

Post-thyroidectomy Hypocalcemia in Patients With History of Bariatric Operations: Current Evidence and Management Options

Spartalis

Thanassa²,

Athanasiadis

et al. 2019

In Vivo

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“…3, calcium absorption might have been impaired as a result of alimentary tract reconstruction. Literature data indicate that severe hypocalcaemia may develop as a consequence of enhanced renal loss of calcium in patients after kidney transplantation with coexistent postoperative hypoparathyroidism [8] as well as in patients with postoperative hypoparathyroidism undergoing Roux-en-Y gastric bypass (RYGB) bariatric surgery with subsequent impairment of calcium gastrointestinal absorption [7].…”

Section: Discussionmentioning

confidence: 99%

“…Particularly severe hypocalcaemia may be observed in patients with postoperative hypoparathyroidism and an underlying condition making calcium deficiency even worse. These underlying conditions include, in particular: impaired calcium absorption from gastrointestinal tract or excessive calcium loss with urine associated with kidney disease [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…0.4 mg/dL occurs, and that it persists for about 6 hours and returns to baseline levels after 16-24 hours, which has been used in the treatment of hypocalcaemia [19,25]. Initially, teriparatide makes bone formation markers increase and after some time, and bone resorption markers are elevated, which is related to intensive bone remodelling and the dominance of resorption process; therefore, long-term use of rhPTH products in osteoporosis is not indicated -the treatment should not exceed 18-24 months [7,26].…”

Section: Introductionmentioning

confidence: 99%

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Leczenie ciężkiej, zagrażającej życiu hipokalcemii ludzkim rekombinowanym teryparatydem pacjentów z pooperacyjną niedoczynnością przytarczyc — seria przypadków

Andrysiak‐Mamos

Zochowska

Kaźmierczyk‐Puchalska

et al. 2015

Endokrynologia Polska

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Introduction: Hypocalcaemia is a common postoperative complication, both after the resection of parathyroid adenoma associated with primary hyperparathyroidism and after total thyroidectomy due to thyroid cancer or nodular goitre. For a few years, in patients with postoperative hypoparathyroidism and severe hypocalcaemia, who cannot discontinue intravenous calcium preparations even with the use of high vitamin D doses, attempts have been made to add recombinant human parathormone (rhPTH) to the treatment schedule. In this work, for the first time in Poland, we demonstrate the potential use of teriparatide for the treatment of severe hypocalcaemia based on three different cases of postoperative hypoparathyroidism. Material and methods: Case 1. Female (52) with postoperative hypoparathyroidism, after total thyroidectomy and the removal of lower left parathyroid gland due to hyperparathyroidism, several weeks after the surgery still required intravenous calcium infusions because of tetany symptoms. Just one month of teriparatide treatment at 20 µg/0.08 mL given in daily subcutaneous injections proved sufficient to control calcium levels with oral calcium and vitamin D preparations during the next few days until total resolution of hypocalcaemia symptoms and the achievement and maintenance of laboratory normocalcaemia in the following weeks. Case 2. Female (33) with hypoparathyroidism following total thyroidectomy in 1996 because of papillary thyroid cancer, with congenital tubulopathy associated with renal loss of calcium and magnesium, and the symptoms of tetany recurring since the day of surgery, requiring intravenous calcium administration every 2-3 days. Currently, the patient has been hospitalised because of venous port infection, the only venous access, which made intravenous therapy impossible. Because of the life-threatening condition of the patient, bridging teriparatide treatment was prepared (20 µg/0.08 mL). Complete resolution of clinical symptoms of hypocalcaemia was obtained with teriparatide doses given every 8-12 hours, which made dose reduction possible. Case 3. Female (52) after major oncological surgery because of laryngopharyngeal and cervical oesophageal cancer with the removal of parathyroid glands, fed through PEG, was admitted to hospital with the symptoms of tetany. Despite treatment intensification, the patient experienced a hypocalcaemic crisis during hospitalisation. Teriparatide treatment at 2 × 20 µg/day resulted in the resolution of tetany symptoms, with gradual normalisation of calcium-phosphate balance parameters during the following days. Conclusions: Based on the analysis of these cases, the conclusion was drawn that the use of recombinant human teriparatide allows for the control of severe hypocalcaemia requiring intravenous infusions of calcium in patients with postoperative hypoparathyroidism.

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“…Several clinical studies have evaluated PTH (1–34) and PTH (1–84) as replacement therapy for hypoparathyroidism. In their case report, Allo Miguel et al report the use of teriparatide in their patient but the response was partial and they opted to reverse the Roux‐en‐Y gastric bypass.…”

Section: Methodsmentioning

confidence: 99%

Thyroidectomy in patients who have undergone gastric bypass surgery

et al. 2018

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Recalcitrant hypocalcaemia in a patient with post-thyroidectomy hypoparathyroidism and Roux-en-Y gastric bypass

Cited by 17 publications

References 18 publications

Post-thyroidectomy Hypocalcemia in Patients With History of Bariatric Operations: Current Evidence and Management Options

Post-thyroidectomy Hypocalcemia in Patients With History of Bariatric Operations: Current Evidence and Management Options

Leczenie ciężkiej, zagrażającej życiu hipokalcemii ludzkim rekombinowanym teryparatydem pacjentów z pooperacyjną niedoczynnością przytarczyc — seria przypadków

Thyroidectomy in patients who have undergone gastric bypass surgery

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