• Gonzalo Allo Miguel, García FernándezElenaEEndocrinology Service, 12 de Octubre University Hospital, UCM, Spain., Guillermo Martínez Díaz-Guerra, María Ángeles Valero Zanuy, Ana Pérez Zapata, Felipe de la Cruz Vigo, and Federico Hawkins Carranza.
• Endocrinology Service, 12 de Octubre University Hospital, UCM, Spain. Electronic address: gonzaloallo.endo@gmail.com.
• Obes Res Clin Pract. 2016 May 1; 10 (3): 344-7.

IntroductionRoux-en-Y gastric bypass (RYGB) places patients at an increased risk of hypocalcaemia due to the reduction in calcium absorption (because the procedure bypasses the duodenum and jejunum) and vitamin D deficiency. Subsequent thyroid surgery increases the risk of severe hypocalcaemia due to potential post-operative hypoparathyroidism. Only a few cases have been published before of this type of treatment-challenging hypocalcaemia.Clinical PresentationWe report the case of a 31-year-old woman with a previous RYGB, who suffered severe and symptomatic chronic hypocalcaemia after total thyroidectomy. She required aggressive therapy with oral calcium and calcitriol and frequent calcium infusions, but there was no improvement in serum calcium level. Due to the lack of response to standard therapy, teriparatide treatment was started (first with subcutaneous injections and thereafter with a multipulse subcutaneous infusor) but the results were disappointing. As there was no response to different medical treatments, reversal of RYGB was performed with no complications and a subsequent sustained increase in serum calcium level.ConclusionsThis case shows that patients with postoperative hypoparathyroidism and RYGB have increased risk of severe recalcitrant symptomatic hypocalcaemia. In our case teriparatide was ineffective but, as this is the first patient reported, more results are needed to evaluate properly the effect of teriparatide in this multifactorial hypocalcaemia. Reversal of RYGB should be considered when medical therapy has failed, because surgery restores an adequate absorption of calcium and vitamin D from previously bypassed duodenum and proximal jejunum.Copyright © 2015 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

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