Pancrelipase treatment in a patient with the history of Roux-en-Y gastric bypass operation that developed resistant hypocalcemia secondary to total thyroidectomy

Baldane, S; Ipekci, SH; Kebapcilar, L

doi:10.1515/enr-2016-0006

Abstract

Objective. Roux-en-Y gastric bypass (RYGB) is an independent risk factor for moderate hypocalcaemia and may lead to the development of resistant hypocalcaemia following thyroid surgery.

Subject and Results. A 35-year old female patient was referred to our hospital by her family physician for treatment of resistant hypocalcaemia. The patient underwent RYGB three years ago and a total thyroidectomy for a benign thyroid nodule one year ago. Calcitriol, calcium carbonate, magnesium oxide, and ergocalciferol therapeutic dosages were incremented. Despite dosage increments, the desired calcium levels were not achieved. In the sixth month after admission to our hospital, pancrelipase was added to patient’s treatment scheme. On the following visit, a good calcium increase had been achieved.

Conclusion. This report presents a case history of RYGB and resistant hypocalcaemia, which developed after thyroid surgery and positively responded to pancrelipase treatment.

References

Alfonso B, Jacobson AS, Alon EE, Via MA. Previous gastric bypass surgery complicating total thyroidectomy. Ear Nose Throat J 94, 12–16, 2015.
Search in Google Scholar
Bischof MG, Heinze G, Vierhapper H. Vitamin D status and its relation to age and body mass index. Horm Res 66, 211–215, 2006.10.1159/000094932
Search in Google Scholar
Bloomberg RD, Fleishman A, Nalle JE, Herron DM, Kini S. Nutritional deficiencies following bariatric surgery: What have we learned? Obes Surg 15, 145–154, 2005.10.1381/0960892053268264
Search in Google Scholar
Carlin AM, Rao DS, Meslemani AM, Genaw JA, Parikh NJ, Levy S, Bhan A, Talpos GB. Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery. Surg Obes Relat Dis 2, 98–103, 2006.10.1016/j.soard.2005.12.001
Search in Google Scholar
Delbridge L, Guinea AI, Reeve TS. Total thyroidectomy for bilateral benign multinodular goiter: effect of changing practice. Arch Surg 134, 1389–1393, 1999.10.1001/archsurg.134.12.1389
Search in Google Scholar
Durr ML, Saunders JR, Califano JA, Tufano RP, Koch WM, Ha PK. Severe hypocalcemia complicating thyroid surgery after Roux-en-Y gastric bypass procedure. Arch Otolaryngol Head Neck Surg 135, 507–510, 2009.10.1001/archoto.2009.20
Search in Google Scholar
Gross JA, Olsen SM, Koch CA, Moore EJ. Severe symptomatic hypocalcemia following total thyroidectomy in a patient with a history of Roux-en-Y gastric bypass surgery. Ear Nose Throat J 93, 6–11, 2014.
Search in Google Scholar
Hundahl S, Cady B, Cunningham M, Mazzaferri E, McKee RF, Rosai J, Shah JP, Fremgen AM, Stewart AK, Holzer S. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the United States during 1996. Cancer 89, 202–217, 2000.10.1002/1097-0142(20000701)89:1<;202::AID-CNCR27>3.0.CO;2-A
Search in Google Scholar
Johnson JM, Maher JW, DeMaria EJ, Downs RW, Wolfe LG, Kellum JM. The long-term effects of gastric bypass on vitamin D metabolism. Ann Surg 243, 701–704, 2006.10.1097/01.sla.0000216773.47825.c1
Search in Google Scholar
Kohn GP, Galanko JA, Overby DW, Farrell TM. Recent trends in bariatric surgery case volume in the United States. Surgery 146, 375–380, 2009.10.1016/j.surg.2009.06.005
Search in Google Scholar
Lo Menzo E, Szomstein S, Rosenthal RJ. Changing trends in bariatric surgery. Scand J Surg 104, 18–23, 2015.10.1177/1457496914552344
Search in Google Scholar
McKenzie TJ, Chen Y, Hodin RA, Shikora SA, Hutter MM, Gaz RD, Moore FD Jr, Lubitz CC. Recalcitrant hypocalcemia after thyroidectomy in patients with previous Roux-en-Y gastric bypass. Surgery 154, 1300–1306, 2013.10.1016/j.surg.2013.04.031
Search in Google Scholar
Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis 4, S109–S184, 2008.10.1016/j.soard.2008.08.00918848315
Search in Google Scholar
Miller AD, Smith KM. Medication and nutrient administration considerations after bariatric surgery. Am J Health Syst Pharm 63, 1852–1857, 2006.10.2146/ajhp06003316990631
Search in Google Scholar
Nguyen NT, Masoomi H, Magno CP, Nguyen XT, Laugenour K, Lane J. Trends in use of bariatric surgery 2003–2008. J Am Coll Surg 213, 261–216, 2011.10.1016/j.jamcollsurg.2011.04.03021624841
Search in Google Scholar
Panazzolo DG, Braga TG, Bergamim A, Pires B, Almeida H, Kraemer-Aguiar LG. Hypoparathyroidism after Rouxen-Y gastric bypass--a challenge for clinical management: a case report. J Med Case Rep 8, 357, 2014.10.1186/1752-1947-8-357423222725348653
Search in Google Scholar
Pietras SM, Holick MF. Refractory hypocalcemia following near-total thyroidectomy in a patient with a prior Rouxen-Y gastric bypass. Obes Surg 19, 524–526, 2009.10.1007/s11695-008-9614-818592328
Search in Google Scholar
Salinger EM, Moore JT. Profound hypocalcemia after neartotal thyroidectomy in a roux-en-Y gastric bypass patient. Am Surg 76, 7–8, 2010.10.1177/000313481007600404
Search in Google Scholar
Slater GH, Ren CJ, Siegel N, Williams T, Barr D, Wolfe B, Dolan K, Fielding GA. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg 8, 48–55, 2004.
Search in Google Scholar
Testa A, Fant V, De Rosa A, Fiore GF, Grieco V, Castaldi P, Persiani R, Rausei S, D’ugo D, De Rosa G. Calcitriol plus hydrochlorothiazide prevents transient post-thyroidectomy hypocalcemia. Horm Metab Res 38, 821–826, 2006.10.1055/s-2006-95650417163358
Search in Google Scholar
Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition 25, 1150–1156, 2009.10.1016/j.nut.2009.03.01219487104
Search in Google Scholar
Tondapu P, Provost D, Adams-Huet B, Sims T, Chang C, Sakhaee K. Comparison of the Absorption of calcium carbonate and calcium citrate after roux-en-Y gastric bypass. Obes Surg 19, 1256–1261, 2009.10.1007/s11695-009-9850-6446917619437082
Search in Google Scholar
Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72, 690–693, 2000.10.1093/ajcn/72.3.69010966885
Search in Google Scholar

Pancrelipase treatment in a patient with the history of Roux-en-Y gastric bypass operation that developed resistant hypocalcemia secondary to total thyroidectomy

Abstract

Paradigm

My account