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Background

Secondary hyperparathyroidism (hPTH) is common following bariatric procedures, especially those with more distal bypasses like the duodenal switch (DS). Setting: Private practice in Raleigh, NC

Methods

Patients undergoing DS between December 1st, 2020 and September 30th, 2021 were included. PTH and 25-OH vitamin D (VitD) levels were obtained preoperatively (preop) and at 3, 6, and 12 months postoperatively. Patients were placed on a vitamin regimen consisting of a multivitamin high in vitamins A,D,E,K, calcium citrate 2400mg, and dry vitamin D3 (cholecalciferol) 30,000 IU daily.

Results

Preoperatively, 31% (n=79/259) of patients had hPTH and 98.7% of those had a preop Vit D level <60 ng/ml. Of the patients with preop hPTH, 63% were normalized at 3 months and 6 months. Of the preop hPTH patients, who had hPTH persisting at 3 months and 6 months, 79% (n=23/29) and 93% (n=13/14) had Vit D <60 at 3 and 6 months, respectively. Of the patients without hPTH preop, 15% (n=21/142) developed hPTH at 3 months and 90.5% (n=19/21) of those had Vit D <60 ng/ml at 3 months. 77.8% (n=7/9) had hPTH resolved at 6 months, and of those that corrected 44.4% (n=4/9) achieved a Vit D >60 ng/ml, and the 2 (22%) that did not correct had a Vit D <30 ng/ml. hPTH was present in only 7% (n=6/81) of patients at 6 months.

Conclusions

In short term follow-up after DS, the vast majority of secondary hPTH cases can be corrected and prevented by achieving Vit D levels >60 ng/ml.