Abstract
Patients with either an autoimmune thyroid disease or thyroid nodules exhibit an increased incidence of celiac sprue. 1 Total thyroidectomy in the setting of celiac sprue poses an increased risk of postoperative hypocalcemia because of a characteristic malabsorption of calcium and magnesium. 2 Hypocalcemia secondary to celiac sprue is independent of the well-described risk of hypoparathyroidism after total thyroidectomy. 3
Celiac sprue is a chronic condition in which there is a characteristic mucosal lesion of the small intestine that impairs nutrient absorption by the involved bowel. 4,5 Intestinal absorption and associated symptoms normalize with the adoption of a gluten-free diet. Nonetheless, chronic calcium and magnesium malabsorption coupled with an associated vitamin D insensitivity may exacerbate postoperative hypocalcemia after total thyroidectomy despite dietary precautions and normal parathyroid function. 2,6
We present an illustrative case of total thyroidectomy for papillary thyroid carcinoma in a patient with Hashimoto's thyroiditis and celiac sprue. Total thyroidectomy in this setting must be undertaken with heightened attention to the risk of postoperative hypocalcemia because of chronic malabsorption of calcium and magnesium.
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