Endocrine Abstracts

Background: Bariatric surgery remains the most effective method of weight loss and can result in partial or complete resolution of multiple obesity-related comorbidities. Bariatric surgery should be performed in conjunction with a comprehensive preoperative assessment and a follow-up plan consisting of nutritional, behavioral, and medical programs. The bariatric surgical procedures are associated with significant long-term complications, primarily malnutrition.

Clinical case: A 56-year-old woman was presented with complaints about tingling in her fingertips, painful muscle cramps, and difficulties with finger extension. It was found out from medical history that total thyroidectomy with parathyroidectomy because of papillary thyroid cancer was performed in 2007 and oral levothyroxine was prescribed. Bariatric surgery SADI-S (sleeve gastrectomy, duodeno–ileal anastomosis) was performed because of morbid obesity in September 2018. On physical examination Chvostek and Trousseau signs were noted. BMI was 39 kg/m². Laboratory examination was carried out. Increased level of TSH and decreased value of calcium and 25-OH vitamin D were revealed. Laboratory results demonstrated postoperative hypothyroidism decompensation due to abnormal gastric acid secretion because of sleeve gastrectomy and postoperative hypoparathyrosis decompensation due to reduced calcium absorption because of duodeno–ileal anastomosis. So, the dosage of calcium, vitamin D and levothyroxine was increased. Also 10% calcium gluconate was prescribed. But compensation of postoperative hypothyroidism and hypoparathyrosis was not achieved. Thus, reconstructive operation was recommended due to ineffective medical treatment of hypothyroidism and hypoparathyrosis.

Conclusion: This clinical case demonstrates that lack of comprehensive preoperative assessment indications to bariatric surgery leads to complication in compensation of comorbid states, such as postoperative hypothyroidism and hypoparathyrosis.

References: 1. Nancy Puzziferri, MD, MS, Thomas B. Roshek III, MD, Helen G. Mayo, BS, MLS, Ryan Gallagher, BA, Steven H. Belle, PhD, MScHyg, and Edward H. Livingston, MD Long-term Follow-up After Bariatric Surgery: A Systematic Review. JAMA. 2014 September 3; 312(9): 934–942.

2. Improved levothyroxine pharmacokinetics after bariatric surgery. Thyroid 2013; 3; 23: 414–9.