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

Area of Science:

• Endocrinology
• Gastroenterology
• Surgical Case Report

Background:

• Roux-en-Y gastric bypass (RYGB) impairs calcium and vitamin D absorption, increasing hypocalcaemia risk.
• Subsequent thyroid surgery, especially total thyroidectomy, heightens this risk due to potential hypoparathyroidism.

Observation:

• A 31-year-old woman with prior RYGB developed severe, symptomatic chronic hypocalcaemia post-thyroidectomy.
• Aggressive medical management, including calcium, calcitriol, and teriparatide, proved ineffective.

Findings:

• Reversal of RYGB was performed due to persistent, treatment-resistant hypocalcaemia.
• The reversal resulted in a sustained increase in serum calcium levels without complications.

Implications:

• Patients with RYGB and postoperative hypoparathyroidism are at high risk for recalcitrant hypocalcaemia.
• RYGB reversal should be considered a viable option for refractory hypocalcaemia when medical therapies fail.
• Further research is needed to assess teriparatide's efficacy in this complex patient group.