weight-loss surgery

People with hypoparathyroidism who want to have surgery should consider the difficulty of keeping their calcium levels in the normal range before undergoing the procedure.

The report of the case with that conclusion, “Challenges of postbariatric hypercalcaemia in pre-existing hypoparathyroidism“, – was published in the magazine Reports of cases of endocrinology, diabetes and metabolism.

Hypoparathyroidism is caused by low levels of parathyroid hormone (PTH) in the blood, which leads to a decrease in the level of calcium in the blood, a medical condition known as hypocalcemia.

The standard treatment for hypoparathyroidism is usually a combination of calcium supplements (calcitriol (an active ingredient in vitamin D)) that are absorbed into the gastrointestinal tract. However, in people who have undergone weight loss surgery or are poorly absorbed in the gut, hypokalemia is difficult to manage.

Australian researchers have recently described a case of a woman with hypoparathyroidism who underwent elective gastrectomy, a weight-loss operation in which a large portion of the stomach is removed to limit food intake and has several complications.

The 46-year-old woman weighed 95 kg (about 209 pounds) – had a body mass index (BMI) of 38.5 kg per square meter (kg / m2:), which at the time of surgery classified him as obese.

In addition to obesity, he had a history of psoriatic arthritis for which he was treated with many immunosuppressive drugs; He also had hypoparathyroidism, which he developed 20 years ago after thyroid removal surgery. However, his hypoparathyroidism has been well managed for years with long-term treatment with oral calcium carbonate “calcitriol”.

He is in 2018. In November, she underwent a gastrectomy, which was transformed into an emergency gastric bypass, a weight-loss operation in which surgeons make a small pocket in the stomach, which is then attached to a portion of the small intestine due to several perforations in the stomach. .

The patient later developed sepsis and was transferred to the intensive care unit four days after surgery. After eating Arrival, his calcium level was low at 0.78 milliliters per liter (mmol / l); normal range: 1.11-1.28 mmol / l. He needed continuous injections of calcium gluconate solution to bring his calcium levels back to normal.

At three months, he began receiving intravenous (venous) calcitrol, which allowed doctors to reduce the frequency of his calcium gluconate injections from five to three a day. During this time, he also sought treatment with lothyroxine to maintain normal levels of thyroid-stimulating hormone.

“Maintenance of normocalcemia [normal calcium levels] “She was pregnant with a patient with pre-existing surgical hypoparathyroidism where oral replacement was impossible,” the researchers wrote.

He remained in the intensive care unit for six months, during which time he underwent more than 20 stomach surgeries and lost 14 kg (about 31 kg).

After more than eight months in the hospital, he eventually recovered to the point where he was able to start taking his usual medications orally. He was discharged, instructed to continue taking calcitriol, as well as a higher dose of calcium supplements (1200 mg twice daily) compared to the dose he had taken once daily before weight loss surgery.

Her calcium levels remained within the normal range until her fourth month, when she weighed 71.8 kg (about 158 ​​pounds) and had a BMI of 29 kg / m2:.

“We recommend a thorough discussion before selective bariatric surgery in patients with pre-existing hypoparathyroidism due to possible difficulties in managing hypokalemia due to impaired gastrointestinal absorption, which is exacerbated by complications,” the researchers wrote.

They noted that while settling in Australia, Natpara, which injects PTH developed by Shire (now part of Takeda), could significantly change the way these patients drive after weight loss surgery. Natpara is approved in the United States and Europe under the Natpar brand for the treatment of hypokalemia associated with hypoparathyroidism.