Bariatric surgery remains the most effective long-term therapy for patients with severe obesity. Micronutrient deficiencies are common problem in post-bariatric patients and a strict follow-up is needed. The goal of this article is to summarize the most frequent deficiencies and the recommendations on their management. A literature review on the topic was carried out, and 57 articles were included. The information was organized into eleven sections and subsections: pre-operative evaluation, bariatric procedures, post-operative evaluation, deficiencies after bariatric surgery (thiamine; vitamin D and calcium; vitamin B12 and iron; folic acid; fat-soluble vitamins; minerals-zinc and copper), conclusion. Late adverse events, namely micronutrient deficiencies, are now challenging the benefit-risk balance of bariatric surgery. It was initially thought that Roux-en-Y gastric bypass could lead to a larger micronutrient deficit when compared to sleeve gastrectomy. Currently, there are no certainties and more studies are needed. Since the majority of patients are relatively young, the long-term follow-up is large. So, there is a need for acquisition of special knowledge and skills by the medical team in primary care setting, once follow-up in specialized centres is limited. Micronutrient deficiencies are the most common problem in post-bariatric patients and needs to be evaluated, at least yearly, after surgery. Nowadays there are recommendations that can guide clinicians in the management of these patients. However, it is necessary studies with similar methodology approaches to reach more accurate conclusions.
Ectopic thyroid is a rare embryological aberration (1 in 4000 to 8000 patients with thyroid disease; 1 in 100 000 to 300 000 normal subjects). Amongst ectopic thyroid glands, 90% are lingual and 10% befall in other locations. Only 1% to 3% of all ectopic thyroid tissues are located in the lateral neck. We report a case of an eight-year-old child with a lateral submandibular ectopic thyroid. Her development and growth patterns were normal. Thyroid function showed a subclinical hypothyroidism. Ultrasonography showed a thyroid cavity filled with adipose tissue and an ectopic thyroid with a heterogeneous structure. A thyroid scan with sodium pertechnetate confirmed the diagnosis. The child was treated with levothyroxine. The repeated thyroid function tests were within the normal limits. This case demonstrates the importance of requesting thyroid function tests and imaging studies in all patients with neck masses.
The prevalence of vitamin D deficiency rickets continues to be a significant health problem in the developmental population in both developed and low-economic areas. Deficiency rickets is a metabolic disease of the growing skeleton, occurring before the closure of the epiphyses of long bones, consisting in disturbed bone mineralization and is etiologically associated with vitamin D and calcium deficiencies. The risk factors for rickets includes a number of conditions leading to a deficiency of vitamin D like chronic kidney disease, liver disease, intestinal malabsorption, impaired fat absorption and metabolism, and conditions requiring long-term total parenteral nutrition. Taking into account the high health risk associated with rickets, its prevalence and demographics, as well as the real and potential burden of the disease, a consensus has been reached and Global Consensus Recommendations are described.
There is a growing interest researching the relationship between vitamin D and various metabolic non-skeletal conditions, such as diabetes mellitus, following the discovery of the existence of vitamin D receptors in various tissues involved in glucose homeostasis, as well as certain polymorphisms of vitamin D receptor are associated with changes in insulin secretion and sensitivity. The contribution of vitamin D in the pathogenesis of type 1 diabetes mellitus and type 2 diabetes mellitus has not been unequivocally proven through studies carried out with supplementation of this vitamin. There seems to be a consensus that patients with diabetes mellitus have a higher prevalence of vitamin D deficit, but the causal relationship of this association remains unclear. Until more data are available, diabetes mellitus patients with risk factors for vitamin D deficiency, with metabolic bone diseases or with vitamin D deficiency should be treated with vitamin D, following established recommendations for vitamin D supplementation for general population risk, but without aiming at improving glycemic control or preventing its associated metabolic complications, although it may offer benefits in this regard.
