Abstract
PurposeCase reports suggest that patients with previous gastric bypass have an increased risk of severe hypocalcemia after total thyroidectomy, but there are no population-based studies. The prevalence of gastric bypass before thyroidectomy and the risk of hypocalcemia after thyroidectomy in patients with previous gastric bypass were investigated.MethodsBy cross-linking The Scandinavian Quality Registry for Thyroid, Parathyroid and Adrenal Surgery with the Scandinavian Obesity Surgery Registry patients operated with total thyroidectomy without concurrent or previous surgery for hyperparathyroidism were identified and grouped according to previous gastric bypass. The risk of treatment with intravenous calcium during hospital stay, and with oral calcium and vitamin D at 6 weeks and 6 months postoperatively was calculated by using multiple logistic regression in the overall cohort and in a 1:1 nested case-control analysis.ResultsWe identified 6115 patients treated with total thyroidectomy. Out of these, 25 (0.4 %) had undergone previous gastric bypass surgery. In logistic regression, previous gastric bypass was not associated with treatment with i.v. calcium (OR 2.05, 95 % CI 0.48–8.74), or calcium and/or vitamin D at 6 weeks (1.14 (0.39–3.35), 1.31 (0.39–4.42)) or 6 months after total thyroidectomy (1.71 (0.40–7.32), 2.28 (0.53–9.75)). In the nested case-control analysis, rates of treatment for hypocalcemia were similar in patients with and without previous gastric bypass.ConclusionPrevious gastric bypass surgery was infrequent in patients undergoing total thyroidectomy and was not associated with an increased risk of postoperative hypocalcemia.
Highlights
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Several case reports indicate that previous bariatric surgery for morbid obesity constitutes a risk factor for severe hypocalcemia after total thyroidectomy (TT) [1,2,3]
We aimed to investigate the frequency and severity of postoperative hypocalcemia in patients with previous Gastric bypass surgery (GBP) undergoing TT, and whether GBP increases the risk for hypocalcemia after TT, using data from nationwide, clinical registers
Summary
Several case reports indicate that previous bariatric surgery for morbid obesity constitutes a risk factor for severe hypocalcemia after total thyroidectomy (TT) [1,2,3]. Gastric bypass surgery (GBP) is the most commonly performed procedure for morbid obesity, and due to the worldwide obesity epidemic, the prevalence of previous GBP is increasing [4]. Hypocalcemia is the most common complication of TT [5] [6] and is caused by intraoperative injury to the parathyroid glands or their blood supply [7]. Low level vitamin D can aggravate postoperative hypocalcemia [8]. Patients with GBP are at risk of developing nutritional deficiencies [9] [10]. In GBP, the absorption of calcium and vitamin D is diminished, possibly due to the exclusion of the duodenum and proximal
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