Roux‐En‐Y Gastric Bypass and Thyroidectomy: Risks and Management of Critical and Refractory Hypocalcemia

Abstract

Objectives: Discuss the increasing prevalence of gastric bypass surgery and the subsequent metabolic and physiologic changes. Discuss the risks, pathophysiology, and management of critical and refractory hypocalcemia following total thyroidectomies in this population in order to optimize perioperative management. Methods: Retrospective review of three cases of patients with a history of Roux-En-Y gastric bypass surgery following total thyroidectomies with or without neck dissections at an academic medical center. Results: All three patients had Roux-En-Y gastric bypass surgeries prior to their thyroidectomies. One patient underwent a total thyroidectomy for Graves disease and became symptomatically hypocalcemic with a nadir serum calcium of 6.3 postoperative day three. Patient two underwent a total thyroidectomy with central and lateral neck dissection for papillary thyroid carcinoma (PTC). This patient became symptomatically hypocalcemic with a nadir serum calcium of 6.4 postoperative day two. Both patients required extensive oral and intravenous calcium supplementation with extended hospitalizations. Patient three underwent a total thyroidectomy and central neck dissection for PTC and discharged postoperative day two with stable calcium levels. Conclusions: With increasing popularity of gastric bypass surgeries, thorough evaluation of prior surgeries is crucial for optimal perioperative management in thyroidectomies. Postoperatively if hypocalcemic, these patients appear to be refractory to oral calcium and calcitriol supplementation. They may require extensive intravenous calcium supplementation and prolonged hospitalization to stabilize serum calcium levels.