Implications of Roux-en-Y Gastric Bypass Surgery on Hypocalcemia in Total Thyroidectomy: A Narrative Review.

Patients who undergo total thyroidectomy after Roux-en-Y gastric bypass are subject to higher risks of postoperative hypocalcemia due to altered gastrointestinal anatomy, but guidelines for management do not exist. Preoperative evaluation of patient's calcium and vitamin D levels should be performed to ensure that any baseline deficiencies are corrected. Postoperative management should include a step-up approach starting with oral calcium and vitamin D supplementation with IV supplementation when needed. In severe cases that progress to permanent hypoparathyroidism, consideration for surgical management to increase calcium absorption may be warranted.