Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggid'Aragona, P.O. Gaetano FucitoMercato San Severino, 84085 Salerno, Italy.
General Surgery and Kidney Transplantation Unit, "San Giovanni di Dio e Ruggi D'Aragona" University Hospital, Scuola Medica Salernitana, 84125 Salerno, Italy.
Nutrients. 2022 Apr 26;14(9):1805. doi: 10.3390/nu14091805.
Background: Hypoparathyroidism-related hypocalcemia is a common complication after total thyroidectomy (TT), particularly if there is a history of prior bariatric surgery. However, it is still unknown if it is the surgery timing or the type of bariatric intervention that increases the risk of developing this complication. Methods: We compared the risk of hypocalcemia (serum calcium levels < 8 mg/dL) and hypoparathyroidism (both transient and permanent) between patients with restrictive procedures (LSG and GB) and patients without a history of obesity surgery in the immediate post-operative period and after 12 months. Hypoparathyroidism was considered permanent if the plasma parathyroid hormone (PTH) levels at 6 months were less than 15 pg/mL and the patient still required oral calcium (calcium carbonate) and vitamin D supplementation, in addition to the supplements that were taken routinely before thyroidectomy. Results: From the 96 patients who underwent TT, 50% had a history of bariatric surgery: 36 LSG and 12 GB. The risk of hypocalcemia was similar in patients with a history of restrictive procedures (31.35%) and in controls (25%) (p = 0.49). Furthermore, hypocalcemia risk was similar between patients with a history of LSG (30.5%) and GB (33%) (p = 0.85). The prevalences of transient and permanent hypoparathyroidism were similar between patients with a history of restrictive procedures and in controls; similarly, no differences were detected between subjects undergoing LSG and GB. Conclusions: Restrictive bariatric surgery (LSG and GB) is not a risk factor for post-thyroidectomy hypocalcemia and hypoparathyroidism and thus did not require a different perioperative supplementation protocol compared to subjects without history of bariatric surgery undergoing TT.
甲状旁腺功能减退相关低钙血症是甲状腺全切除术（TT）后的常见并发症，尤其是既往有减重手术史者。然而，目前尚不清楚是手术时机还是减重干预类型增加了发生这种并发症的风险。方法：我们比较了即刻术后和 12 个月后有和无肥胖手术史的患者之间发生低钙血症（血清钙水平＜8mg/dL）和甲状旁腺功能减退（包括一过性和永久性）的风险。如果患者在 6 个月时的血浆甲状旁腺激素（PTH）水平＜15pg/mL，且仍需口服钙（碳酸钙）和维生素 D 补充剂，此外还需补充甲状腺切除术前常规服用的补充剂，则认为甲状旁腺功能减退为永久性。结果：在 96 例行 TT 的患者中，50%有减重手术史：36 例行胃袖状切除术（LSG），12 例行胃旁路术（GB）。有减重手术史患者（31.35%）和对照组（25%）发生低钙血症的风险相似（p=0.49）。此外，有 LSG 史（30.5%）和有 GB 史（33%）的患者发生低钙血症的风险相似（p=0.85）。有减重手术史患者和对照组患者中，一过性和永久性甲状旁腺功能减退的发生率相似；同样，LSG 和 GB 患者之间也未发现差异。结论：限制型减重手术（LSG 和 GB）不是甲状腺切除术后低钙血症和甲状旁腺功能减退的危险因素，因此与无减重手术史行 TT 的患者相比，不需要采用不同的围手术期补充方案。
