The malabsorption state caused by small intestinal bypass surgery may result in nutritional deficiencies. The drastic loss of jejunum and ileum interferes with normal absorption of various substances, leading to metabolic derangement, vitamin deficiencies, and even nutritional cirrhosis of the liver (1). We have recently seen a patient with hypothyroidism and obesity who developed severe malabsorption of thyroid hormones after a bypass operation.
A 38-year-old white woman was referred for evaluation of hypothyroidism in March 1977. She had been grossly obese ( >160 kg) for most of her adult life and had undergone a small intestinal bypass in August 1974.