Background

We present the case of 56 year old woman with a history of a Roux-en-Y gastric bypass (RYGB) who developed permanent hypoparathyroidism as a complication of total thyroidectomy. She eventually required reversal of her gastric bypass to a sleeve gastrectomy to maintain her serum calcium levels on oral supplementation.

Methods

Case Presentation: Our patient is a 56-year-old woman with a history of an uncomplicated RYGB for obesity who developed papillary thyroid carcinoma requiring total thyroidectomy. This was complicated by ischemia of all four of her parathyroid glands causing permanent hypoparathyroidism. We describe her post-thyroidectomy course complicated by refractory hypocalcemia requiring IV calcium infusions and subsequent gastrostomy tube placement in the gastric remnant to maintain calcium homeostasis. Enteral calcium supplementation through the G-tube was successful until she was placed on recombinant injectable parathyroid hormone which allowed her to supplement calcium orally for approximately two years. Unfortunately, the injectable formulation was recalled due to the risk of osteosarcoma, and she opted to undergo reversal of her RYGB followed by conversion to sleeve gastrectomy in order to avoid replacement of G-tube and to maintain her weight loss.

Conclusions

Our patient had no complications from her laparoscopic revision of RYGB to sleeve gastrectomy and lost seven additional BMI points post-operatively. Her serum calcium levels remained stable on oral calcium supplementation at her one year follow-up visit. Her case suggests that patients with a history of RYGB may be at a higher risk of symptomatic hypocalcemia after thyroidectomy.